Provider Demographics
NPI:1346410446
Name:WELLS, WILLIAM HARRISON
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARRISON
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37567
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0526
Mailing Address - Country:US
Mailing Address - Phone:803-328-0030
Mailing Address - Fax:803-980-7276
Practice Address - Street 1:1665 HERLONG CT STE B
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1193
Practice Address - Country:US
Practice Address - Phone:803-328-0030
Practice Address - Fax:803-980-7276
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP94252Medicare UPIN