Provider Demographics
NPI:1023355211
Name:WIDMAN, DONNA MARIE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:WIDMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E BIG BEAVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1435
Mailing Address - Country:US
Mailing Address - Phone:248-817-6629
Mailing Address - Fax:248-817-6694
Practice Address - Street 1:700 E BIG BEAVER RD STE D
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1435
Practice Address - Country:US
Practice Address - Phone:248-817-6629
Practice Address - Fax:248-817-6694
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health