Provider Demographics
NPI:1982804720
Name:HIGGINS, MIRANDA LOPER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LOPER
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:BROOKE
Other - Last Name:LOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:51 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-7459
Mailing Address - Country:US
Mailing Address - Phone:334-663-2687
Mailing Address - Fax:
Practice Address - Street 1:3000 SCHATULGA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3117
Practice Address - Country:US
Practice Address - Phone:706-568-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent