Provider Demographics
NPI:1003603317
Name:WELLER, EMILY CLARICE (APC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLARICE
Last Name:WELLER
Suffix:
Gender:
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PUBLIC SQ N STE B
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1254
Mailing Address - Country:US
Mailing Address - Phone:706-864-5674
Mailing Address - Fax:
Practice Address - Street 1:72 PUBLIC SQ N STE B
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1254
Practice Address - Country:US
Practice Address - Phone:706-864-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health