Provider Demographics
NPI:1992457048
Name:WIGGINS, AMANDA NICOLE (LGMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WHITE TAIL DEER CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5751
Mailing Address - Country:US
Mailing Address - Phone:410-940-8480
Mailing Address - Fax:
Practice Address - Street 1:5654 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3574
Practice Address - Country:US
Practice Address - Phone:410-541-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist