Provider Demographics
NPI:1801819891
Name:WELLS, CAROL P (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:P
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2920
Mailing Address - Country:US
Mailing Address - Phone:813-404-0919
Mailing Address - Fax:
Practice Address - Street 1:206 S BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2920
Practice Address - Country:US
Practice Address - Phone:813-404-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health