Healthcare Provider Details

I. General information

NPI: 1629353818
Provider Name (Legal Business Name): KRISTINE MELSON WELLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLAREMONT LN STE 103
CROZET VA
22932-3455
US

IV. Provider business mailing address

325 FOUR LEAF LN #12
CHARLOTTESVILLE VA
22903-9203
US

V. Phone/Fax

Practice location:
  • Phone: 434-466-1588
  • Fax: 866-289-5249
Mailing address:
  • Phone: 434-466-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: