Provider Demographics
NPI:1508510108
Name:WELLS, ERICA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-3867
Mailing Address - Country:US
Mailing Address - Phone:847-977-8501
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3109
Practice Address - Country:US
Practice Address - Phone:305-936-1002
Practice Address - Fax:305-936-1022
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical