Provider Demographics
NPI:1609137108
Name:HIGGINS-CROSS, KELLY M (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:HIGGINS-CROSS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
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Mailing Address - Street 1:9515 DULWICH CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2850
Mailing Address - Country:US
Mailing Address - Phone:757-944-0293
Mailing Address - Fax:
Practice Address - Street 1:8617 CHAPIN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-5425
Practice Address - Country:US
Practice Address - Phone:757-944-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC208951041C0700X
NCC0090581041C0700X
VA09040089381041C0700X
NCP0079301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC009058OtherLICENSED CLINICAL SOCIAL WORK STATE OF NORTH CAROLINA
VA0904008938OtherLICENSED CLINICAL SOCIAL WORKER STATE OF VIRGINIA
MELC20895OtherLICENSED CLINICAL SOCIAL WORKER STATE OF MAINE
NC3049-AOtherNORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD
VA0904008938OtherLICENSED CLINICAL SOCIAL WORKER STATE OF VIRGINIA
NC126452OtherTHE INTERNATIONAL CERTIFICATION & RECIPROCITY CONSORTIUM