Provider Demographics
NPI:1427256890
Name:HIGGINBOTHAM, TIFFANY SHEA (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHEA
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:SHEA
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:JAMES H. QUILLEN VETERANS AFFAIRS MEDICAL CENTER
Mailing Address - Street 2:SYDNEY AND LAMONT STREET
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-2871
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:SYDNEY AND LAMONT STREET
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66381041C0700X
TN0005349811041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool