Provider Demographics
NPI:1598111205
Name:WELLS, DENISE RAE (MA, LPCA, ATR)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:RAE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA, LPCA, ATR
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:RAE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATR
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:APT. B
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-2282
Mailing Address - Country:US
Mailing Address - Phone:704-915-8935
Mailing Address - Fax:
Practice Address - Street 1:1552 UNION RD
Practice Address - Street 2:SUITE E
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5523
Practice Address - Country:US
Practice Address - Phone:704-833-0154
Practice Address - Fax:704-833-7076
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12116101Y00000X, 101YM0800X, 251G00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health