Provider Demographics
NPI:1407305329
Name:WIGGINS, LONDA DENISE
Entity Type:Individual
Prefix:MRS
First Name:LONDA
Middle Name:DENISE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 RANCHSIDE TERRENCE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7277
Mailing Address - Country:US
Mailing Address - Phone:937-694-6958
Mailing Address - Fax:
Practice Address - Street 1:2512 RANCHSIDE TERRACE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-7277
Practice Address - Country:US
Practice Address - Phone:937-694-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst