Provider Demographics
NPI:1255516571
Name:WIDGER, CHRISTIE JAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:JAN
Last Name:WIDGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 BELVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-7860
Mailing Address - Country:US
Mailing Address - Phone:256-757-3835
Mailing Address - Fax:
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW
Practice Address - Street 2:SUITE 303A-B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4815
Practice Address - Country:US
Practice Address - Phone:256-655-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health