Individual
BRADLEY HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSA
Contact information
Practice address
145 VICTORIA DR, LAKE CHARLES, LA 70611-4641
(337) 855-9773
Mailing address
209 PARK AVE, LAKE CHARLES, LA 70601-5967
(337) 304-3719
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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