Provider Demographics
NPI:1932895315
Name:WELLS, TONYA K (LLMSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:K
Last Name:WELLS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 KENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3452
Mailing Address - Country:US
Mailing Address - Phone:313-378-3477
Mailing Address - Fax:
Practice Address - Street 1:26711 WOODWARD AVE STE 208
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1368
Practice Address - Country:US
Practice Address - Phone:313-378-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511154641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical