Healthcare Provider Details

I. General information

NPI: 1386405686
Provider Name (Legal Business Name): THE WELLSIDE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 BROWNSBERGER CIRCLE
FLETCHER NC
28732-2873
US

IV. Provider business mailing address

PO BOX 1005
FLETCHER NC
28732-1005
US

V. Phone/Fax

Practice location:
  • Phone: 828-949-1695
  • Fax:
Mailing address:
  • Phone: 828-949-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA LEE BROWN
Title or Position: OWNER, COUNSELOR
Credential: PHD, LCMHC
Phone: 859-788-0337