Provider Demographics
NPI:1972025260
Name:HIGGINS, LEAH DIANE (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:DIANE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2509
Mailing Address - Country:US
Mailing Address - Phone:847-962-7784
Mailing Address - Fax:
Practice Address - Street 1:8401 UNIVERSITY EXEC PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1360
Practice Address - Country:US
Practice Address - Phone:800-311-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO113361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical