Provider Demographics
NPI:1053661124
Name:WELLS, PEGGIE (LCSWA, MSW)
Entity Type:Individual
Prefix:
First Name:PEGGIE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSWA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11313
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-1313
Mailing Address - Country:US
Mailing Address - Phone:336-261-6893
Mailing Address - Fax:
Practice Address - Street 1:100 W SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2946
Practice Address - Country:US
Practice Address - Phone:336-261-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health