Provider Demographics
NPI:1508518440
Name:WELLS, DAYRON L (CDCA, QMHS)
Entity Type:Individual
Prefix:
First Name:DAYRON
Middle Name:L
Last Name:WELLS
Suffix:
Gender:M
Credentials:CDCA, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2501
Mailing Address - Country:US
Mailing Address - Phone:614-286-9150
Mailing Address - Fax:
Practice Address - Street 1:35 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5762
Practice Address - Country:US
Practice Address - Phone:614-371-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X, 101YM0800X, 101YP2500X
OHCDCA.179388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YM0800XOtherTHE CHANGE AGENCY
OHCDCA.179388OtherOHIO CHEMICAL DEPENDENCY PROFESSIONALS BOARD