Healthcare Provider Details

I. General information

NPI: 1851364244
Provider Name (Legal Business Name): KENNETH WELLS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 COPORATION LANE SUITE 200
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

4445 CORPORATION LN STE 200
VIRGINIA BEACH VA
23462-3262
US

V. Phone/Fax

Practice location:
  • Phone: 757-213-6800
  • Fax: 757-240-5936
Mailing address:
  • Phone: 757-213-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003278
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701003278
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: