Provider Demographics
NPI:1407167281
Name:WELLS, VICKI (MA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3535
Mailing Address - Country:US
Mailing Address - Phone:510-356-2755
Mailing Address - Fax:510-356-2755
Practice Address - Street 1:3292 JORDAN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3535
Practice Address - Country:US
Practice Address - Phone:510-356-2755
Practice Address - Fax:510-356-2755
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst