Provider Demographics
NPI:1235389248
Name:BE WELL THERAPY, PLLC
Entity Type:Organization
Organization Name:BE WELL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:704-334-3170
Mailing Address - Street 1:2128 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5126
Mailing Address - Country:US
Mailing Address - Phone:704-334-3170
Mailing Address - Fax:704-334-3181
Practice Address - Street 1:2128 COMMONWEALTH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5126
Practice Address - Country:US
Practice Address - Phone:704-334-3170
Practice Address - Fax:704-334-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6804251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103780Medicaid