Healthcare Provider Details

I. General information

NPI: 1730347220
Provider Name (Legal Business Name): LINDA JODIE HIGGINS LCDC, ACADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4091 SUMMERHILL SQ
TEXARKANA TX
75503-2768
US

IV. Provider business mailing address

4091 SUMMERHILL SQ
TEXARKANA TX
75503-2768
US

V. Phone/Fax

Practice location:
  • Phone: 903-792-8887
  • Fax: 903-792-8799
Mailing address:
  • Phone: 903-792-8887
  • Fax: 903-792-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8243
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACADC/A-119
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS/A-119
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: