Provider Demographics
NPI:1760252738
Name:WIGGINS, MARY CAITLIN
Entity Type:Individual
Prefix:DR
First Name:MARY CAITLIN
Middle Name:
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 1:61 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:GA
Mailing Address - Zip Code:30217-7313
Mailing Address - Country:US
Mailing Address - Phone:678-603-7107
Mailing Address - Fax:
Practice Address - Street 1:406 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2232
Practice Address - Country:US
Practice Address - Phone:678-603-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor