Provider Demographics
NPI:1710128715
Name:WELLONS, ALYCE ELLINGTON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALYCE
Middle Name:ELLINGTON
Last Name:WELLONS
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 1:207 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3947
Mailing Address - Country:US
Mailing Address - Phone:404-664-3110
Mailing Address - Fax:
Practice Address - Street 1:207 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3947
Practice Address - Country:US
Practice Address - Phone:404-664-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical