Provider Demographics
NPI:1235535253
Name:WELLS, REGINALD LAMAR (LPC, CPCS)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:LAMAR
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 GLENWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2900
Mailing Address - Country:US
Mailing Address - Phone:404-907-3936
Mailing Address - Fax:
Practice Address - Street 1:148 GLENWOOD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2900
Practice Address - Country:US
Practice Address - Phone:404-907-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP1600X
GALPC005943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003189469AMedicaid