Provider Demographics
NPI:1235429473
Name:WELLMAN, LEONARD LEROY (MA,, CAC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:LEROY
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:MA,, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 152A
Mailing Address - Street 2:
Mailing Address - City:GLEN EASTON
Mailing Address - State:WV
Mailing Address - Zip Code:26039-9730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101YA0400X
WV1003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1003OtherBCBS