Healthcare Provider Details

I. General information

NPI: 1760956874
Provider Name (Legal Business Name): VANESSA R WELLS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BRICKSTONE SQ STE 201
ANDOVER MA
01810-1497
US

IV. Provider business mailing address

16 ROYAL CREST DR APT 9
NORTH ANDOVER MA
01845-6448
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-3485
  • Fax:
Mailing address:
  • Phone: 919-810-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13193
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: