Provider Demographics
NPI:1073707261
Name:WELLMAN, ANGELA R (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E KANAWHA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1207
Mailing Address - Country:US
Mailing Address - Phone:614-325-9096
Mailing Address - Fax:
Practice Address - Street 1:33 E KANAWHA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1207
Practice Address - Country:US
Practice Address - Phone:614-325-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0602151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional