Provider Demographics
NPI:1639850498
Name:WELLS, DAVONNA L
Entity Type:Individual
Prefix:
First Name:DAVONNA
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 ELSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1944
Mailing Address - Country:US
Mailing Address - Phone:610-818-9713
Mailing Address - Fax:
Practice Address - Street 1:1100 FIRST AVE STE 101
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1348
Practice Address - Country:US
Practice Address - Phone:484-302-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical