=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770449878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMDEN COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2026
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 MACY DR
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076-6346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-765-5965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 880 MARIETTA HWY STE 630-245
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30075-6755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-765-5965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | BROOKE WIDDER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 804-475-3969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------