Provider Demographics
NPI:1932903937
Name:WIGINTON, CHANDRA RAE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:RAE
Last Name:WIGINTON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4682 E UNIVERSITY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8190
Mailing Address - Country:US
Mailing Address - Phone:432-848-6944
Mailing Address - Fax:
Practice Address - Street 1:4682 E UNIVERSITY BLVD STE D
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8190
Practice Address - Country:US
Practice Address - Phone:432-848-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1728085101YP2500X
TX92736101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional