Provider Demographics
NPI:1003288606
Name:WIGGINS, LPC, JONI (MA)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:WIGGINS, LPC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CENTRAL BLVD, SUITE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420
Mailing Address - Country:US
Mailing Address - Phone:843-478-9441
Mailing Address - Fax:
Practice Address - Street 1:108 CENTRAL AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3079
Practice Address - Country:US
Practice Address - Phone:843-478-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6427101YP2500X
SC5990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional