Provider Demographics
NPI:1952371700
Name:WIGGINS, CARTER T (LCSW)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:T
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12955 BISCAYNE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2021
Mailing Address - Country:US
Mailing Address - Phone:305-895-3307
Mailing Address - Fax:305-895-1737
Practice Address - Street 1:12955 BISCAYNE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2021
Practice Address - Country:US
Practice Address - Phone:305-895-3307
Practice Address - Fax:305-895-1737
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7316OtherBLUE CROSS BLUE SHIELD
FL000109300Medicaid