Provider Demographics
NPI:1467693689
Name:WELLS, DARIA (LCSW, RN)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW, RN
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 57101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7101
Mailing Address - Country:US
Mailing Address - Phone:904-861-8882
Mailing Address - Fax:
Practice Address - Street 1:1955 U.S. 1 SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-829-0814
Practice Address - Fax:904-829-6174
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34691041C0700X
FL9267873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse