Healthcare Provider Details

I. General information

NPI: 1730046079
Provider Name (Legal Business Name): HAILEY WELLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 ALLEGHENY AVE
TOWSON MD
21204-4252
US

IV. Provider business mailing address

408 ALLEGHENY AVE
TOWSON MD
21204-4252
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HAILEY WELLER
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: LPC, LCPC, NCC
Phone: 410-231-3773