Provider Demographics
NPI:1053665661
Name:WIGGINS-PEPPERS, CYNTHIA (EDD,LCASA,MA,QMHP)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:WIGGINS-PEPPERS
Suffix:
Gender:F
Credentials:EDD,LCASA,MA,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SPRING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6209
Mailing Address - Country:US
Mailing Address - Phone:919-351-5483
Mailing Address - Fax:
Practice Address - Street 1:171 SPRING PARK RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6209
Practice Address - Country:US
Practice Address - Phone:919-351-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2537-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)