Provider Demographics
NPI:1356697031
Name:WELLS, ANTHONY ORLANDO (PHD, LCP)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ORLANDO
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 ALBEMARLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4716
Mailing Address - Country:US
Mailing Address - Phone:540-818-3379
Mailing Address - Fax:540-572-4690
Practice Address - Street 1:221 ALBEMARLE AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4716
Practice Address - Country:US
Practice Address - Phone:540-818-3379
Practice Address - Fax:540-572-4690
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical