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General NPI Number Information
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NPI Number | 1861953739
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Entity Type | Individual
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Provider Name | LAQUANDA WIGGINS CCTP, NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1775 TALIAFERRO TRL
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City | MONTGOMERY
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State | AL
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Zip | 36117-7758
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Country | US
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Telephone | 334-245-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 TALIAFERRO TRL
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City | MONTGOMERY
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State | AL
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Zip | 36117-7758
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Country | US
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Telephone | 334-245-3361
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Fax | 334-239-7716
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4185
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License Number State | AL
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