Provider Demographics
NPI:1790003663
Name:WELLSPRING CENTER PLLC
Entity Type:Organization
Organization Name:WELLSPRING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHINLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LPA, NCC
Authorized Official - Phone:910-308-7270
Mailing Address - Street 1:1968 HWY 172
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460
Mailing Address - Country:US
Mailing Address - Phone:910-308-7270
Mailing Address - Fax:888-768-0060
Practice Address - Street 1:1968 HWY 172
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-308-7270
Practice Address - Fax:888-768-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty