Provider Demographics
NPI:1356746614
Name:WELLS, NICOLE K (PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5888
Mailing Address - Fax:757-446-5918
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5888
Practice Address - Fax:757-446-5918
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356746614OtherMULTIPLAN
VA1356746614OtherVIRGINIA PREMIER HEALTH PLAN
1356746614OtherTRICARE/CHAMPUS
VA1356746614Medicaid
VA1356746614OtherVIRGINIA HEALTH NETWORK
VA1356746614OtherMAGELLAN HEALTHCARE
VA1356746614OtherANTHEM BEHAVIORAL HEALTH
VA1356746614OtherCIGNA BEHAVIORAL HEALTH
VA1356746614OtherBEACON HEALTH OPTIONS
VA1356746614OtherUNITED BEHAVIORAL HEALTH
VA1356746614OtherAETNA BEHAVIORAL HEALTH
VA1356746614OtherUSA MANAGED CARE
VA1356746614OtherOPTIMA BEHAVIORAL HEALTH
VA1356746614OtherUNITED BEHAVIORAL HEALTH