Provider Demographics
NPI:1639645278
Name:WIGGINS, DONALD G (LPCA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 LONGSTREET DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6131
Mailing Address - Country:US
Mailing Address - Phone:919-215-0235
Mailing Address - Fax:
Practice Address - Street 1:7516 LONGSTREET DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6131
Practice Address - Country:US
Practice Address - Phone:919-215-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional