Provider Demographics
NPI:1649904624
Name:WIGGINS, JOYCE ANN
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANN
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-0247
Mailing Address - Country:US
Mailing Address - Phone:804-458-5500
Mailing Address - Fax:804-458-5501
Practice Address - Street 1:4701 OWENS WAY STE 200
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2366
Practice Address - Country:US
Practice Address - Phone:804-458-5500
Practice Address - Fax:804-458-5501
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-166861106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician