Provider Demographics
NPI:1265867428
Name:WIGGINS, DAWN (MED, EDS, LMFT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MED, EDS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PLAZA REAL S
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4837
Mailing Address - Country:US
Mailing Address - Phone:561-221-5575
Mailing Address - Fax:
Practice Address - Street 1:101 PLAZA REAL S
Practice Address - Street 2:SUITE 226
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4837
Practice Address - Country:US
Practice Address - Phone:561-221-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist