Provider Demographics
NPI:1477175750
Name:HIGGINS, JANICE (SUDCC IV CS)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:SUDCC IV CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N IMPERIAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1325
Mailing Address - Country:US
Mailing Address - Phone:619-414-0016
Mailing Address - Fax:
Practice Address - Street 1:2456 CANCUN CT
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-8861
Practice Address - Country:US
Practice Address - Phone:619-414-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6182101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1037Medicaid