Healthcare Provider Details

I. General information

NPI: 1932649506
Provider Name (Legal Business Name): KAREN YVETTE WELLS LPN, MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AVIEMORE DR
PINEHURST NC
28374-9797
US

IV. Provider business mailing address

45 AVIEMORE DR
PINEHURST NC
28374-9797
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-3347
  • Fax: 910-255-4394
Mailing address:
  • Phone: 910-235-3347
  • Fax: 910-255-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015652
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010920
License Number StateNC

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: