Provider Demographics
NPI:1164727798
Name:WELLS, KENNETH P (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:P
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 STEEPLE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23433-1615
Mailing Address - Country:US
Mailing Address - Phone:757-371-9042
Mailing Address - Fax:757-238-7765
Practice Address - Street 1:1589 STEEPLE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23433-1615
Practice Address - Country:US
Practice Address - Phone:757-371-9042
Practice Address - Fax:757-238-7765
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional