MEDICARE: MS. NICHELLE NICHOL WIGGINS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC-0011222	DE
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PC-0011222	OTHER	DE	PROFESSIONAL COUNSELOR OF MENTAL HEALTH LICENSE

General Provider Information

NPI Number	:	1306486097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICHELLE NICHOL WIGGINS LPC

Provider Business Mailing Address
First Line	:	701 E CATHEDRAL RD STE 45-1374
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-486-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E CATHEDRAL RD STE 45-1374
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-486-4431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	08/01/2025

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