Provider Demographics
NPI:1730652330
Name:WIGGINTON, EVETTE CHERREL (LPC)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:CHERREL
Last Name:WIGGINTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 CURTIS CLARK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4626
Mailing Address - Country:US
Mailing Address - Phone:361-442-6932
Mailing Address - Fax:512-291-5657
Practice Address - Street 1:1533 S BROWNLEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3131
Practice Address - Country:US
Practice Address - Phone:361-884-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13870101YA0400X
TX16461101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13870OtherLCDC
TX16461OtherLPC