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General NPI Number Information
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NPI Number | 1821704719
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Entity Type | Organization
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Legal Business Name | SUMARA WIGGINS LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 11/06/2023
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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 |
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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 | 804-800-2721
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Authorized Official
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Title or Position | CLINICIAN/OWNER
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Name | MS. SUMARA KEYANNA WIGGINS
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Credential | LPC
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Telephone | 804-301-3424
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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 |
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License Number State |
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