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Individual

LOLITA D WIGGS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, LPC

Contact information

Practice address
3711 EXECUTIVE CENTER DR, SUITE 101, MARTINEZ, GA 30907-0951
(706) 210-8855
(678) 541-7699
Mailing address
3711 EXECUTIVE CENTER DRIVE, SUITE 101, MARTINEZ, GA 30907-0952
(706) 210-8855
(678) 541-7699

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008158
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003153686A
GA
Enumeration date
11/08/2012
Last updated
12/30/2014
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