Provider Demographics
NPI:1861933111
Name:HIGGINS, LISA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 HAMILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4902
Mailing Address - Country:US
Mailing Address - Phone:423-877-5631
Mailing Address - Fax:423-803-6511
Practice Address - Street 1:1603 HAMILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4902
Practice Address - Country:US
Practice Address - Phone:423-877-5631
Practice Address - Fax:423-803-6511
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2892101YP2500X
GA008908101YP2500X
TN000184644101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool