Provider Demographics
NPI:1174851141
Name:WIGGINS, MARCELLA MARIE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:MARIE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HIGHWAY 365 STE 110
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6251
Mailing Address - Country:US
Mailing Address - Phone:409-729-0400
Mailing Address - Fax:409-729-0453
Practice Address - Street 1:210 S VILLAGE ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-5243
Practice Address - Country:US
Practice Address - Phone:866-573-8001
Practice Address - Fax:866-573-8008
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14425101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor