Individual
LATICIA RENE WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S., C.M.
Contact information
Practice address
23 E ROSS AVE, SAPULPA, OK 74066-6423
(918) 227-2016
Mailing address
23 E ROSS AVE, SAPULPA, OK 74066-6423
(918) 227-2016
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/08/2008
Last updated
10/08/2008
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