Individual
ELISSA KERGOSIEN WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
11031 SYDELLE DR, NORTH CHESTERFIELD, VA 23235-3329
(228) 363-1468
Mailing address
11031 SYDELLE DR, NORTH CHESTERFIELD, VA 23235-3329
(228) 363-1468
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008185
VA
Other
Enumeration date
06/13/2025
Last updated
06/13/2025
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