Provider Demographics
NPI:1447431135
Name:WELLING, MARIAN ROBERTA (MA)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:ROBERTA
Last Name:WELLING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:ROBERTA
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5172
Mailing Address - Country:US
Mailing Address - Phone:304-243-1598
Mailing Address - Fax:304-234-3511
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010579Medicaid