Provider Demographics
NPI:1114454212
Name:WELLS, ANGEL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 EAGLES NEST CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-5453
Mailing Address - Country:US
Mailing Address - Phone:470-241-3855
Mailing Address - Fax:
Practice Address - Street 1:445 EAGLES NEST CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-5453
Practice Address - Country:US
Practice Address - Phone:470-241-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst