Provider Demographics
NPI:1962705152
Name:HIGGINBOTHAM, SANDRA PRUITT (MA, LPC, NCC, MBA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:PRUITT
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:MA, LPC, NCC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3540
Mailing Address - Country:US
Mailing Address - Phone:210-478-6037
Mailing Address - Fax:
Practice Address - Street 1:1800 NE LOOP 410
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5213
Practice Address - Country:US
Practice Address - Phone:210-478-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional