Provider Demographics
NPI:1679967731
Name:M HIGGINBOTTOM, LAWONNA (LPCC-S, DRHS)
Entity type:Individual
Prefix:
First Name:LAWONNA
Middle Name:
Last Name:M HIGGINBOTTOM
Suffix:
Gender:F
Credentials:LPCC-S, DRHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25367
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-0367
Mailing Address - Country:US
Mailing Address - Phone:216-354-5355
Mailing Address - Fax:
Practice Address - Street 1:291 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1718
Practice Address - Country:US
Practice Address - Phone:216-354-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800721-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0264748Medicaid