Provider Demographics
NPI:1831486505
Name:HIGGINS, LISA DINA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DINA
Last Name:HIGGINS
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 1:1942 MADRAS ST SE
Mailing Address - Street 2:APARTMENT 1056
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2196
Mailing Address - Country:US
Mailing Address - Phone:503-362-2627
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE
Practice Address - Street 2:SUITE 530
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1882
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor