Individual
JOHN WIDENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LMFT
Contact information
Practice address
125 E MONROE ST, THOMASVILLE, GA 31792-5142
(678) 577-8795
(404) 860-2111
Mailing address
125 E MONROE ST, THOMASVILLE, GA 31792-5142
(678) 577-8795
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC011205
GA
106H00000X
Marriage & Family Therapist
MFT001705
GA
Other
Enumeration date
08/06/2016
Last updated
01/25/2022
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