Provider Demographics
NPI:1518606060
Name:HIGGINS, RANDALL MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:MICHAEL
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290153
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92329-0153
Mailing Address - Country:US
Mailing Address - Phone:760-221-8894
Mailing Address - Fax:
Practice Address - Street 1:12555 MARIPOSA RD STE J
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-6010
Practice Address - Country:US
Practice Address - Phone:760-221-8894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1083391041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical