Healthcare Provider Details

I. General information

NPI: 1194403840
Provider Name (Legal Business Name): HAILEY WELLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 UNION ST
SAN FRANCISCO CA
94123-4426
US

IV. Provider business mailing address

1777 UNION ST
SAN FRANCISCO CA
94123-4426
US

V. Phone/Fax

Practice location:
  • Phone: 410-231-3773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC16664
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: