Provider Demographics
NPI:1679232953
Name:WELLS, PRECIOUS (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PRECIOUS
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 COLBORNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1902
Mailing Address - Country:US
Mailing Address - Phone:410-428-1268
Mailing Address - Fax:
Practice Address - Street 1:3925 COLBORNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1902
Practice Address - Country:US
Practice Address - Phone:443-583-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13365101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC13365OtherMARYLAND LICENSE
MDLC13365Medicaid