Provider Demographics
NPI:1225297351
Name:HIGGINBOTHAM, MELINDA G (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:G
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BLUE LAKE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-977-3003
Mailing Address - Fax:
Practice Address - Street 1:3104 BLUE LAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2345
Practice Address - Country:US
Practice Address - Phone:205-977-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional