Healthcare Provider Details

I. General information

NPI: 1174651996
Provider Name (Legal Business Name): DAVID D HIGHFIELD SR. M.DIV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 HIGHWAY 100 SUITE 101
CENTERVILLE TN
37033
US

IV. Provider business mailing address

704 HIGHWAY 100 SUITE 101
CENTERVILLE TN
37033
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-3573
  • Fax: 931-729-9330
Mailing address:
  • Phone: 931-729-3573
  • Fax: 931-729-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLDC00000000235
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: