Healthcare Provider Details

I. General information

NPI: 1083029862
Provider Name (Legal Business Name): MARIAN HIGGINS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON RD 703
ATHENS GA
30606-7204
US

IV. Provider business mailing address

PO BOX 82045
ATHENS GA
30608-2045
US

V. Phone/Fax

Practice location:
  • Phone: 706-425-8900
  • Fax:
Mailing address:
  • Phone: 706-425-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: