Provider Demographics
NPI:1831902980
Name:DERIGGS, ANIYA
Entity type:Individual
Prefix:
First Name:ANIYA
Middle Name:
Last Name:DERIGGS
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 1:2920 SUSSEX ST APT 9
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5065
Mailing Address - Country:US
Mailing Address - Phone:321-946-7360
Mailing Address - Fax:
Practice Address - Street 1:2563 DOC LOFTIN RD
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-8559
Practice Address - Country:US
Practice Address - Phone:252-495-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health