Provider Demographics
NPI:1861827438
Name:WIGGINS, MICHELLE L (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14635 S HARRELLS FERRY RD
Mailing Address - Street 2:3A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2959
Mailing Address - Country:US
Mailing Address - Phone:225-751-5412
Mailing Address - Fax:225-751-5847
Practice Address - Street 1:14635 S HARRELLS FERRY RD
Practice Address - Street 2:3A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2959
Practice Address - Country:US
Practice Address - Phone:225-751-5412
Practice Address - Fax:225-751-5847
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
460671529OtherFEDERAL ID