MEDICARE: MR. JEFFREY L. WELLS LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	644	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982703971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY L. WELLS LCAS

Provider Business Mailing Address
First Line	:	473 KINGSWOOD DR
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-5128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 W MAIN ST STE A
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-2519
Country	:	US
Telephone Number	:	828-248-1067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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