Provider Demographics
NPI:1437287463
Name:WELLS, MARISSA (MA)
Entity Type:Individual
Prefix:
First Name:MARISSA
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 1:524 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-8644
Mailing Address - Country:US
Mailing Address - Phone:803-581-8311
Mailing Address - Fax:803-329-7141
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4541
Practice Address - Country:US
Practice Address - Phone:803-328-9600
Practice Address - Fax:803-329-7141
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional