Healthcare Provider Details

I. General information

NPI: 1174851141
Provider Name (Legal Business Name): MARCELLA MARIE WIGGINS ME.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S VILLAGE ST
WOODVILLE TX
75979-5243
US

IV. Provider business mailing address

2300 HIGHWAY 365 STE 110
NEDERLAND TX
77627-6251
US

V. Phone/Fax

Practice location:
  • Phone: 866-573-8001
  • Fax: 866-573-8008
Mailing address:
  • Phone: 409-729-0400
  • Fax: 409-729-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: