Provider Demographics
NPI:1124868021
Name:HIGGENBOTTOM, ALELIA PAIGE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ALELIA
Middle Name:PAIGE
Last Name:HIGGENBOTTOM
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CARTA WAY APT 2028
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6413
Mailing Address - Country:US
Mailing Address - Phone:901-326-9031
Mailing Address - Fax:
Practice Address - Street 1:2340 CARTA WAY APT 2028
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6413
Practice Address - Country:US
Practice Address - Phone:901-326-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7014101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health