Provider Demographics
NPI:1063060663
Name:WIGGINS, DAPHNE CORDELIA (MA)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:CORDELIA
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 RIPPLING STREAM RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1119
Mailing Address - Country:US
Mailing Address - Phone:919-641-6639
Mailing Address - Fax:
Practice Address - Street 1:304 RIPPLING STREAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1119
Practice Address - Country:US
Practice Address - Phone:919-641-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25844101YA0400X
NC15639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)