Provider Demographics
NPI:1164116505
Name:WELLS, JEFFREY L (BA, LMBT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:WELLS
Suffix:
Gender:M
Credentials:BA, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W KING ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2543
Mailing Address - Country:US
Mailing Address - Phone:919-201-3915
Mailing Address - Fax:
Practice Address - Street 1:147 W KING ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2543
Practice Address - Country:US
Practice Address - Phone:919-201-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty