Provider Demographics
NPI:1235527458
Name:HIGGINBOTHAM, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CENTER ST STE 214
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7140
Mailing Address - Country:US
Mailing Address - Phone:817-276-6412
Mailing Address - Fax:817-276-6438
Practice Address - Street 1:301 S CENTER ST STE 214
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7140
Practice Address - Country:US
Practice Address - Phone:817-276-6412
Practice Address - Fax:817-276-6438
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66234101YP2500X
TX201598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional