Provider Demographics
NPI:1821704719
Name:SUMARA WIGGINS LLC
Entity Type:Organization
Organization Name:SUMARA WIGGINS LLC
Other - Org Name:JOURNEY THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUMARA
Authorized Official - Middle Name:KEYANNA
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-301-3424
Mailing Address - Street 1:2806 BOTONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2068
Mailing Address - Country:US
Mailing Address - Phone:804-301-3424
Mailing Address - Fax:804-800-2721
Practice Address - Street 1:1905 HUGUENOT RD STE 306
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4312
Practice Address - Country:US
Practice Address - Phone:804-301-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty