Provider Demographics
NPI:1235963349
Name:WIGGINS, JILLIAN (LPCMH)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 ANDREWS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-5246
Mailing Address - Country:US
Mailing Address - Phone:609-408-8002
Mailing Address - Fax:
Practice Address - Street 1:156 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7314
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC-0011714OtherSTATE OF DELAWARE DIVISION OF PROFESSIONAL REGULATION