Provider Demographics
NPI:1497150080
Name:HIGGINS, GREG B (MA)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:B
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2502
Mailing Address - Country:US
Mailing Address - Phone:336-529-9274
Mailing Address - Fax:
Practice Address - Street 1:840 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2502
Practice Address - Country:US
Practice Address - Phone:336-529-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-26
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist