Provider Demographics
NPI:1508519679
Name:HIGGINS, SHANDA (LPC)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2554
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-2554
Mailing Address - Country:US
Mailing Address - Phone:843-509-6732
Mailing Address - Fax:
Practice Address - Street 1:310 N GUM ST STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6874
Practice Address - Country:US
Practice Address - Phone:843-509-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9389OtherSC BOARD LICENSE