Provider Demographics
NPI:1619304441
Name:KELLY-HIGGS, NIKIA
Entity Type:Individual
Prefix:
First Name:NIKIA
Middle Name:
Last Name:KELLY-HIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 EVANS MILL CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3239
Mailing Address - Country:US
Mailing Address - Phone:202-257-8001
Mailing Address - Fax:
Practice Address - Street 1:4201 MARTIN LUTHER KING JR AVE SW
Practice Address - Street 2:401 MISSISSIPPI AVE SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1328
Practice Address - Country:US
Practice Address - Phone:202-645-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500795351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical