Provider Demographics
NPI:1407520695
Name:HIGGS, MALLERY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MALLERY
Middle Name:
Last Name:HIGGS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SUGARLOAF PKWY STE 400-374
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4344
Mailing Address - Country:US
Mailing Address - Phone:678-524-4033
Mailing Address - Fax:
Practice Address - Street 1:6600 SUGARLOAF PKWY STE 400-374
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4344
Practice Address - Country:US
Practice Address - Phone:678-524-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012184101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health