| Doctor Name: | JIMMY D WIDENER |
| NPI Number: | 1386684215 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | VA0701003500 |
| Business Practice Address: | Rte 19 - 460 Cedar Bluff, VA - 24609 |
| Business Phone Number: | 2769646702 |
| Business Fax Number: | 2769645669 |
| Mailing Address: | Po Box 810, CEDAR BLUFF |
| State: | VA |
| Postal Code: | 24609 |
| Phone Number: | 2769646702 |
| Fax Number: | 2769645669 |
| NPI Enumeration Date: | 06/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | VA0701003500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |