Healthcare Provider Details

I. General information

NPI: 1801728886
Provider Name (Legal Business Name): HEADWATERS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STORER ST STE 403B
KENNEBUNK ME
04043-6885
US

IV. Provider business mailing address

2 STORER ST STE 403B
KENNEBUNK ME
04043-6885
US

V. Phone/Fax

Practice location:
  • Phone: 207-814-7387
  • Fax: 207-200-9719
Mailing address:
  • Phone: 207-814-7387
  • Fax: 207-200-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL WELLS
Title or Position: OWNER
Credential: PHD, LCPC
Phone: 207-370-7376