Healthcare Provider Details

I. General information

NPI: 1003724907
Provider Name (Legal Business Name): SAMUEL WELLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 GEORGIA AVE NW STE 4
WASHINGTON DC
20012-1754
US

IV. Provider business mailing address

3121 ADAMS MILL RD NW APT B
WASHINGTON DC
20010-2611
US

V. Phone/Fax

Practice location:
  • Phone: 202-285-1690
  • Fax:
Mailing address:
  • Phone: 763-528-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200012741
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: