Provider Demographics
NPI:1093353534
Name:HIGGINS, SAMANTHA SUZETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUZETTE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1001
Mailing Address - Country:US
Mailing Address - Phone:757-926-0262
Mailing Address - Fax:757-273-6842
Practice Address - Street 1:809 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1001
Practice Address - Country:US
Practice Address - Phone:757-926-0262
Practice Address - Fax:757-273-6842
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040142741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical