Provider Demographics
NPI:1679097299
Name:WELLS, JOSHUA (MA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:M
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CACC
Mailing Address - Street 1:199 S HERLONG
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-323-6399
Mailing Address - Fax:
Practice Address - Street 1:199 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1186
Practice Address - Country:US
Practice Address - Phone:803-323-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)