Provider Demographics
NPI:1184844904
Name:WELLS, STEPHANIE ELLEN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MAGNOLIA AVE APT 343
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1610
Mailing Address - Country:US
Mailing Address - Phone:501-372-2970
Mailing Address - Fax:188-846-8931
Practice Address - Street 1:225 S PULASKI ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1925
Practice Address - Country:US
Practice Address - Phone:501-372-2970
Practice Address - Fax:888-468-9318
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR984C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR984COtherLCSW