Provider Demographics
NPI:1982596227
Name:HIGGINBOTHAM, DYLAN (MA OF COUNSELING)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:MA OF COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3201
Mailing Address - Country:US
Mailing Address - Phone:214-766-4068
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 402
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3394
Practice Address - Country:US
Practice Address - Phone:214-766-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61689086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health