| Doctor Name: | MR. WILLIAM CLEVELAND TIDWELL |
| NPI Number: | 1326114448 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | LPC005068 |
| Business Practice Address: | 405 Alabama Avenue Bremen, GA - 30110 |
| Business Phone Number: | 7705372367 |
| Business Fax Number: | 7705371203 |
| Mailing Address: | 405 Alabama Avenue, BREMEN |
| State: | GA |
| Postal Code: | 30110 |
| Phone Number: | 7705372367 |
| Fax Number: | 7705371203 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 06/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC005068 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |