Provider Demographics
NPI:1669034757
Name:WELLS, STEPHANIE D (CADC II)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:WELLS
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2997 OWENS MEADOW DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2558
Mailing Address - Country:US
Mailing Address - Phone:678-223-4187
Mailing Address - Fax:
Practice Address - Street 1:4306 ORANGE DRIVE NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6371
Practice Address - Country:US
Practice Address - Phone:901-606-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1365101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty