Provider Demographics
NPI:1932723509
Name:WIDNER, DONALD BOYD (LCDC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:BOYD
Last Name:WIDNER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 HARROUN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3433
Mailing Address - Country:US
Mailing Address - Phone:972-548-0209
Mailing Address - Fax:
Practice Address - Street 1:1505 HARROUN AVE STE F
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3433
Practice Address - Country:US
Practice Address - Phone:972-548-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)