Provider Demographics
NPI:1043919277
Name:HIGGINS, MATTHEW C
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 PURPLE SAGE DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-5601
Mailing Address - Country:US
Mailing Address - Phone:540-454-5044
Mailing Address - Fax:
Practice Address - Street 1:1642 PURPLE SAGE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-5601
Practice Address - Country:US
Practice Address - Phone:540-454-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health