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Individual
MRS. SHANNA WIDEMAN
Active
Individual
MRS. SHANNA WIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, AADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TP0814X
Psychoanalysis Psychologist
—
NULL
103TR0400X
Rehabilitation Psychologist
—
NULL
Other
Enumeration date
04/23/2009
Last updated
10/23/2015
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