Provider Demographics
NPI:1609112762
Name:MATTHEWS-WELLS, CRYSTALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTALL
Middle Name:
Last Name:MATTHEWS-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 1:731 TILGHMAN DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5507
Mailing Address - Country:US
Mailing Address - Phone:910-249-4219
Mailing Address - Fax:899-279-1991
Practice Address - Street 1:731 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5507
Practice Address - Country:US
Practice Address - Phone:910-249-4219
Practice Address - Fax:866-279-1991
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020850103TC0700X
NC4775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical