Black Sheep Trauma and Recovery LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLACK SHEEP TRAUMA AND RECOVERY LLC

Practice address

125 E Monroe St
Thomasville, GA 31792-5142

Phone

(404) 860-2111

NPI assigned

Jan 20, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Widener, LPC, LMFT

Title

Owner

Phone

(678) 577-8795

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1497407506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E MONROE ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925142",
            "telephone_number": "678-577-8795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E MONROE ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925142",
            "telephone_number": "404-860-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK SHEEP TRAUMA AND RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "WIDENER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-577-8795",
        "authorized_official_credential": "LPC, LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003226805A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.