Healthcare Provider Details

I. General information

NPI: 1891820064
Provider Name (Legal Business Name): CINDY GORDON WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E GROVER ST
SHELBY NC
28150-3919
US

IV. Provider business mailing address

217 WELLS MILL RD
BOSTIC NC
28018
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: