=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558499426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHIATRIC ASSOCIATES OF SPARTANBURG, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 943 N CHURCH ST
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29303-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-585-2214
-----------------------------------------------------
Fax | 864-585-5608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 N CHURCH ST
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29303-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-585-2214
-----------------------------------------------------
Fax | 864-585-5608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENNETH W WELLS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 864-585-2214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2064
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1304
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 06871
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------