Provider Demographics
NPI:1851364244
Name:WELLS, KEN L (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:L
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 CORPORATION LN STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3262
Mailing Address - Country:US
Mailing Address - Phone:757-213-6800
Mailing Address - Fax:
Practice Address - Street 1:4445 COPORATION LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-213-6800
Practice Address - Fax:757-240-5936
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003278101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
385289OtherBCBS
385289OtherANTHEM PPO
089635OtherSENTARA OPTIMA
2193340OtherCIGNA
201351OtherCOMPSYCH
2123895OtherMAMSI
327272OtherMANAGED HEALTH NETWORK
385289OtherANTHEM HEALTHKEEPERS
VA005413281Medicaid
488552OtherMAGELLAN