Provider Demographics
NPI:1023534146
Name:HIGGINS, EBONY (LMMT)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 COMMONS EAST DR APT L
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0443
Mailing Address - Country:US
Mailing Address - Phone:704-412-8371
Mailing Address - Fax:
Practice Address - Street 1:11121 CARMEL COMMONS BLVD STE 17
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4495
Practice Address - Country:US
Practice Address - Phone:704-412-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12286225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist