Provider Demographics
NPI:1639822059
Name:WIGGINS-MOTTON, VIRGINIA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:WIGGINS-MOTTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 LEGACY DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4488
Mailing Address - Country:US
Mailing Address - Phone:256-318-4514
Mailing Address - Fax:
Practice Address - Street 1:2938 LEGACY DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4488
Practice Address - Country:US
Practice Address - Phone:256-318-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3073G101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3073GOtherALABAMA SOCIAL WORK BOARD OF EXAMINERS