Provider Demographics
NPI:1790953677
Name:WIGGINTON, LORI NORTHCUTT (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:NORTHCUTT
Last Name:WIGGINTON
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 BUCKNER LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2854
Mailing Address - Country:US
Mailing Address - Phone:615-519-7799
Mailing Address - Fax:
Practice Address - Street 1:2942 BUCKNER LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2854
Practice Address - Country:US
Practice Address - Phone:615-519-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN544-2083Medicaid