Healthcare Provider Details

I. General information

NPI: 1033561147
Provider Name (Legal Business Name): ACACIA PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 EMBARCADERO DEL NORTE STE 102
GOLETA CA
93117-5106
US

IV. Provider business mailing address

281 MAGNOLIA AVE STE 300
GOLETA CA
93117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 805-699-6668
  • Fax:
Mailing address:
  • Phone: 888-699-4873
  • Fax: 805-472-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26572
License Number StateCA

VIII. Authorized Official

Name: HARLAN HIGGINBOTHAM
Title or Position: PSYCHOLOGIST / OWNER
Credential: PSY.D.
Phone: 805-364-2482