Provider Demographics
NPI:1851880827
Name:WIGGINS, LATIESHA DAVIS (CSAC)
Entity Type:Individual
Prefix:MRS
First Name:LATIESHA
Middle Name:DAVIS
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CHESAPEAKE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-5325
Mailing Address - Country:US
Mailing Address - Phone:757-276-3331
Mailing Address - Fax:757-282-7866
Practice Address - Street 1:5750 CHESAPEAKE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-5325
Practice Address - Country:US
Practice Address - Phone:757-966-1728
Practice Address - Fax:757-282-7866
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103279101YA0400X
VA0704015011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)