MEDICARE: MRS. LEAH DIANE HIGGINS LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	PO11336	NC

General Provider Information

NPI Number	:	1972025260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH DIANE HIGGINS LCSWA

Provider Business Mailing Address
First Line	:	2831 FLORIDA AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2509
Country	:	US
Telephone Number	:	847-962-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 UNIVERSITY EXEC PARK DR STE 106
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1360
Country	:	US
Telephone Number	:	800-311-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2017
Last Update Date	:	07/09/2017

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