Healthcare Provider Details

I. General information

NPI: 1790003663
Provider Name (Legal Business Name): WELLSPRING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 HWY 172
SNEADS FERRY NC
28460
US

IV. Provider business mailing address

1968 HWY 172
SNEADS FERRY NC
28460
US

V. Phone/Fax

Practice location:
  • Phone: 910-308-7270
  • Fax: 888-768-0060
Mailing address:
  • Phone: 910-308-7270
  • Fax: 888-768-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ALICIA L CHINLUND
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: MA, LPC, LPA, NCC
Phone: 910-308-7270