Individual
JOHN WIDMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC, LCDC-III
Contact information
Practice address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Mailing address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.091022
OH
101YM0800X
Mental Health Counselor
Primary
E-0501359
OH
101YP2500X
Professional Counselor
E.0501359
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
OHIO DEPT. DRUG & ALCOHOL (GROUP)
OH
01
—
0074946
OHIO DEPT. MENTAL HEALTH (GROUP)
OH
01
—
01-0693
CARF
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
10/21/2013
Last updated
11/05/2017
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