Provider Demographics
NPI:1619281995
Name:HIGGINS, LISA M (MED, NCC, LCMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MED, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:VT
Mailing Address - Zip Code:05822-8635
Mailing Address - Country:US
Mailing Address - Phone:802-673-9758
Mailing Address - Fax:
Practice Address - Street 1:332 ELM ST
Practice Address - Street 2:
Practice Address - City:BARTON
Practice Address - State:VT
Practice Address - Zip Code:05822-8635
Practice Address - Country:US
Practice Address - Phone:802-673-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health