Provider Demographics
NPI:1073807277
Name:HIGGINS, SHIRLEY KAY (MA, MFT, LADC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:KAY
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MA, MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3903
Mailing Address - Country:US
Mailing Address - Phone:860-647-1324
Mailing Address - Fax:
Practice Address - Street 1:519 CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3903
Practice Address - Country:US
Practice Address - Phone:860-647-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000854101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$Medicaid