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General NPI Number Information
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NPI Number | 1104515873
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Entity Type | Organization
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Legal Business Name | RAQUEL WELLS, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 120 PLEASANT HILL AVE N STE 200Q
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City | SEBASTOPOL
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State | CA
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Zip | 95472-3167
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Country | US
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Telephone | 415-294-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S MAIN ST # 100-535
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4284
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Country | US
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Telephone | 707-503-0569
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Fax | 707-261-1258
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAQUEL WELLS
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Credential | LCSW
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Telephone | 415-535-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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