Provider Demographics
NPI:1013062546
Name:WELLS, CAROL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 E SANTA ANA CANYON RD STE 100-154
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1102
Mailing Address - Country:US
Mailing Address - Phone:714-692-5555
Mailing Address - Fax:
Practice Address - Street 1:8018 E SANTA ANA CANYON RD STE 100-154
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1102
Practice Address - Country:US
Practice Address - Phone:714-692-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist