Healthcare Provider Details

I. General information

NPI: 1003404088
Provider Name (Legal Business Name): BYRON REESE WELLS LCMHC, NCC, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 YOUNGS COVE RD
CANDLER NC
28715-9312
US

IV. Provider business mailing address

300 YOUNGS COVE RD
CANDLER NC
28715-9312
US

V. Phone/Fax

Practice location:
  • Phone: 828-782-3304
  • Fax: 828-544-1201
Mailing address:
  • Phone: 336-817-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: