Provider Demographics
NPI:1720827363
Name:WIDENHOUSE, LEXI
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:WIDENHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1349
Mailing Address - Country:US
Mailing Address - Phone:843-737-3474
Mailing Address - Fax:
Practice Address - Street 1:108 PALMETTO PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7969
Practice Address - Country:US
Practice Address - Phone:803-399-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health