Healthcare Provider Details

I. General information

NPI: 1376462648
Provider Name (Legal Business Name): ERICA WELLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 HEDGECOTH ST NW
PALM BAY FL
32907-7718
US

IV. Provider business mailing address

1326 HEDGECOTH ST NW
PALM BAY FL
32907-7718
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-0396
  • Fax:
Mailing address:
  • Phone: 321-345-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: