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General NPI Number Information
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NPI Number | 1023104338
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Entity Type | Individual
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Provider Name | PHILLIP M HIGDON MS LADAC CCS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 110 SKYLINE DRIVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801
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Country | US
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Telephone | 479-968-1298
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Fax | 479-968-6053
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Provider Business Mailing Address
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Address Line | 350 SALEM ROAD SUITE 1
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-336-8300
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Fax | 501-329-3572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0245L
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7828E
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License Number State | AR
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