Provider Demographics
NPI:1114086329
Name:KIGGINS, THOMAS B (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:KIGGINS
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 BUSINESS 17 E
Mailing Address - Street 2:PO BOX 409
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8666
Mailing Address - Country:US
Mailing Address - Phone:910-880-9905
Mailing Address - Fax:910-253-8028
Practice Address - Street 1:639 CREEKWAY CIR SE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8266
Practice Address - Country:US
Practice Address - Phone:910-880-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0071861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007790Medicaid