Provider Information for 1114009453
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Mr. DAVID WIGGINS LPC, PhD
Sex: Male
NPI: 1114009453
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1114009453 | ||||||||||||
| Enumeration Date | 2006-10-19 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6031 CHAGALL DR ROANOKE, VA 24018-5289 United States Phone: 540-772-2995 | Fax: | ||||||||||||
| Primary Practice Address | 4656 BRAMBLETON AVE ROANOKE, VA 24018-3437 United States Phone: 540-772-8043 | Fax:540-772-8242 | ||||||||||||
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