Provider Demographics
NPI:1295233237
Name:STEPHANIE LEONARD HIGDON
Entity type:Organization
Organization Name:STEPHANIE LEONARD HIGDON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-206-5627
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-0809
Mailing Address - Country:US
Mailing Address - Phone:706-206-5627
Mailing Address - Fax:866-252-7137
Practice Address - Street 1:122 COURTHOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633
Practice Address - Country:US
Practice Address - Phone:706-206-5627
Practice Address - Fax:866-252-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060351041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty