| Black Sheep Trauma And Recovery Llc | |
|
125 E Monroe St Thomasville GA 31792-5142 | |
| (404) 860-2111 | |
| Not Available |
| Full Name | Black Sheep Trauma And Recovery Llc |
|---|---|
| Speciality | Counselor |
| Location | 125 E Monroe St, Thomasville, Georgia |
| Authorized Official Name and Position | John Widener (OWNER) |
| Authorized Official Contact | 6785778795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Sheep Trauma And Recovery Llc 125 E Monroe St Thomasville GA 31792-5142 Ph: (678) 577-8795 | Black Sheep Trauma And Recovery Llc 125 E Monroe St Thomasville GA 31792-5142 Ph: (404) 860-2111 |
| NPI Number | 1497407506 |
|---|---|
| Provider Enumeration Date | 01/20/2022 |
| Last Update Date | 01/25/2022 |
| Certification Date | 01/25/2022 |
| Medicare PECOS PAC ID | 4789020157 |
|---|---|
| Medicare Enrollment ID | O20240307001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497407506 | NPI | - | NPPES |
| 003226805A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| Provider Name | John E Widener |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467906537 PECOS PAC ID: 0547606915 Enrollment ID: I20240307001925 |
Graves Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 319 N Stevens St, Thomasville, GA 31792 Phone: 229-221-3442 Fax: 855-560-7664 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 367 Shoreline Dr, Apt A&b, Thomasville, GA 31757 Phone: 229-225-4335 Fax: 229-225-4374 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14244 Us Highway 19 S, Thomasville, GA 31757 Phone: 229-225-4335 Fax: 229-225-4374 | |
Southwest Community Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 S Pinetree Blvd, Thomasville, GA 31792 Phone: 229-227-2990 Fax: 229-225-4052 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 407 Cloverdale Drive, Thomasville, GA 31792 Phone: 229-233-8904 | |
Crossing Jordan Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 N Broad St Ste 302, Thomasville, GA 31792 Phone: 912-212-5803 Fax: 229-512-3767 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1102 Smith Ave, Thomasville, GA 31792 Phone: 229-225-4335 Fax: 229-225-4374 |