Provider Demographics
NPI:1740478353
Name:WIGGINS, ELLEN FORD (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:FORD
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 LOUGHRAN TER
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5639
Mailing Address - Country:US
Mailing Address - Phone:202-253-4636
Mailing Address - Fax:301-203-8683
Practice Address - Street 1:1901 MISSISSIPPI AVE SE
Practice Address - Street 2:SUITE #104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6117
Practice Address - Country:US
Practice Address - Phone:202-436-3060
Practice Address - Fax:202-610-9522
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3018531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical