Healthcare Provider Details

I. General information

NPI: 1487391082
Provider Name (Legal Business Name): J HIGGINS COUNSELING LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WHEATFIELD ST STE 28
NORTH TONAWANDA NY
14120-7034
US

IV. Provider business mailing address

525 WHEATFIELD ST STE 28
NORTH TONAWANDA NY
14120-7034
US

V. Phone/Fax

Practice location:
  • Phone: 716-202-2900
  • Fax:
Mailing address:
  • Phone: 716-202-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN HIGGINS
Title or Position: MEMBER/SHAREHOLDER
Credential: LCSWR
Phone: 716-202-2900