Provider Demographics
NPI:1386033256
Name:WELLS, CARRIE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LICSW
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 681007
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-1007
Mailing Address - Country:US
Mailing Address - Phone:334-358-2455
Mailing Address - Fax:
Practice Address - Street 1:1820 GLYNWOOD DR
Practice Address - Street 2:STE B
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5533
Practice Address - Country:US
Practice Address - Phone:334-358-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3552C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical