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General NPI Number Information
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NPI Number | 1770229171
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Entity Type | Individual
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Provider Name | LISA HIGGINS
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Gender | Female
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 515 DENMARK ST
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City | STATESBORO
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State | GA
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Zip | 30458-5287
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Country | US
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Telephone | 843-949-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BLUE MOON XING STE 3
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City | POOLER
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State | GA
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Zip | 31322-9798
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Country | US
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Telephone | 843-949-7085
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Fax |
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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 | 510356
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 007923
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 007923
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License Number State | GA
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