Provider Demographics
NPI:1265145577
Name:HIGGINS, VIKKI JEAN
Entity type:Individual
Prefix:
First Name:VIKKI
Middle Name:JEAN
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 1:11891 NEELYTON RD
Mailing Address - Street 2:
Mailing Address - City:SHADE GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17255-9247
Mailing Address - Country:US
Mailing Address - Phone:717-489-2949
Mailing Address - Fax:
Practice Address - Street 1:11891 NEELYTON RD
Practice Address - Street 2:
Practice Address - City:SHADE GAP
Practice Address - State:PA
Practice Address - Zip Code:17255-9247
Practice Address - Country:US
Practice Address - Phone:717-489-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist