Provider Demographics
NPI:1104545417
Name:HIGGINS, STAFFORD JERALD JR (LGSW)
Entity type:Individual
Prefix:MR
First Name:STAFFORD
Middle Name:JERALD
Last Name:HIGGINS
Suffix:JR
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CONN AVE NW STE 450
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4359
Mailing Address - Country:US
Mailing Address - Phone:202-368-0378
Mailing Address - Fax:
Practice Address - Street 1:300 S VAN DORN ST APT R107
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4333
Practice Address - Country:US
Practice Address - Phone:229-375-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001379104100000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker