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General NPI Number Information
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NPI Number | 1003481771
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Entity Type | Individual
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Provider Name | SUMARA WIGGINS LPC, CRC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 1905 HUGUENOT RD STE 306
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4312
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Country | US
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Telephone | 804-301-3424
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Fax | 804-800-2751
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Provider Business Mailing Address
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Address Line | 2806 BOTONE AVE
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-2068
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Country | US
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Telephone | 804-301-3424
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Fax | 804-800-2751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701010433
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License Number State | VA
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