Healthcare Provider Details

I. General information

NPI: 1649147687
Provider Name (Legal Business Name): JUSTIN MICHAEL HIGGINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 211
WHITE MARSH MD
21162-5504
US

IV. Provider business mailing address

3070 EBBTIDE DR
EDGEWOOD MD
21040-2902
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9500
  • Fax:
Mailing address:
  • Phone: 443-987-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17154
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: