Basic Information
| Provider Information | |||||||||
| NPI: | 1831486505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | DINA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1942 MADRAS ST SE | ||||||||
| Address2: | APARTMENT 1056 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973062196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033622627 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 MARKET ST NE | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973011882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033905637 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.