Provider Demographics
NPI:1407933146
Name:WELLFORD, CHRIS DUNBAR (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:DUNBAR
Last Name:WELLFORD
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:NAVAL HOSPITAL
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
Mailing Address - Phone:910-471-5016
Mailing Address - Fax:910-471-5016
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-449-9122
Practice Address - Fax:910-449-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0455JOtherBCBS OF NORTH CAROLINA
NC6000632Medicaid
2821591Medicare ID - Type Unspecified