Provider Demographics
NPI:1548507148
Name:HIGGINBOTHAM, JANICE HALL (LMSW, MAC, NCAC II)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:HALL
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:LMSW, MAC, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1252
Mailing Address - Street 2:SADAC,
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-9931
Mailing Address - Country:US
Mailing Address - Phone:864-582-7588
Mailing Address - Fax:864-582-0431
Practice Address - Street 1:187 WEST BROAD STREET
Practice Address - Street 2:SUITE 200, SADAC
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3234
Practice Address - Country:US
Practice Address - Phone:864-582-7588
Practice Address - Fax:864-582-0431
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500212101YA0400X
SC1955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)