Provider Demographics
NPI:1912123241
Name:WELLSPRING OF HENDERSON COUNTY, INC.
Entity Type:Organization
Organization Name:WELLSPRING OF HENDERSON COUNTY, INC.
Other - Org Name:WELLSPRING COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PERSIS
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DIDIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-692-7255
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-1778
Mailing Address - Country:US
Mailing Address - Phone:828-692-7255
Mailing Address - Fax:828-692-7830
Practice Address - Street 1:220 3RD AVE W # A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4308
Practice Address - Country:US
Practice Address - Phone:828-692-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty