Provider Demographics
NPI:1689921249
Name:WELLS, DARIA SIMONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DARIA
Middle Name:SIMONE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 WELBY WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-999-2140
Mailing Address - Fax:850-270-6572
Practice Address - Street 1:1931 WELBY WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4462
Practice Address - Country:US
Practice Address - Phone:850-999-2140
Practice Address - Fax:850-270-6572
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 111151041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010440900Medicaid