Provider Demographics
NPI:1245995398
Name:HIGGINBOTHAM, MICHAEL BROOKS (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BROOKS
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1406 SILVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE F1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2291
Practice Address - Country:US
Practice Address - Phone:479-333-1811
Practice Address - Fax:501-302-4006
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7485-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical