Provider Demographics
NPI:1912602152
Name:HIGGS, JERALD THOMAS (LCSWA)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:THOMAS
Last Name:HIGGS
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WARREN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8172
Mailing Address - Country:US
Mailing Address - Phone:843-592-0819
Mailing Address - Fax:
Practice Address - Street 1:298 WARREN CREEK RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8172
Practice Address - Country:US
Practice Address - Phone:843-592-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0183841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical