Individual
J.D. WEIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2750 HERITAGE MANOR WALK, DECATUR, GA 30034
(404) 317-9566
Mailing address
2750 HERITAGE MANOR WALK, DECATUR, GA 30034-1002
(404) 317-9566
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
FL-MH21136
FL
101YM0800X
Mental Health Counselor
Primary
GA-LPC009051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC009051
STATE LICENSE
GA
01
—
MH21136
STATE LICENSE
FL
Enumeration date
10/07/2008
Last updated
11/21/2024
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