Provider Demographics
NPI:1144402413
Name:WELLMAN, ERIC T (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 161
Mailing Address - Street 2:
Mailing Address - City:VALLEY GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26060-8931
Mailing Address - Country:US
Mailing Address - Phone:304-336-4282
Mailing Address - Fax:304-336-4282
Practice Address - Street 1:4150 WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2534
Practice Address - Country:US
Practice Address - Phone:724-941-6640
Practice Address - Fax:724-941-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004735101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health