Healthcare Provider Details

I. General information

NPI: 1114838109
Provider Name (Legal Business Name): TREVISE A HIGGINS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 HINTON FARM WAY
DACULA GA
30019-2252
US

IV. Provider business mailing address

522 HINTON FARM WAY
DACULA GA
30019-2252
US

V. Phone/Fax

Practice location:
  • Phone: 347-369-4479
  • Fax:
Mailing address:
  • Phone: 347-424-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: