Provider Demographics
NPI:1780837393
Name:WELLS, EMILY WOODVILLE (CMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WOODVILLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 EDWIN DR
Mailing Address - Street 2:STE. 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4541
Mailing Address - Country:US
Mailing Address - Phone:757-490-9488
Mailing Address - Fax:
Practice Address - Street 1:319 EDWIN DR
Practice Address - Street 2:STE. 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4541
Practice Address - Country:US
Practice Address - Phone:757-490-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019000883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist