MEDICARE: MRS. SABRIE RENEE WIGGINS-ROSE LCPC

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	101YP2500X	Professional Counselor	LC5642	MD

General Provider Information

NPI Number	:	1942604483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SABRIE RENEE WIGGINS-ROSE LCPC

Provider Business Mailing Address
First Line	:	2612 TALBOT CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2017
Country	:	US
Telephone Number	:	301-356-5276
Fax Number	:

Provider Business Practice Location Address
First Line	:	4095 SILVER PARK TER
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-3047
Country	:	US
Telephone Number	:	301-356-5276
Fax Number	:

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

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	05/24/2022

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