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General NPI Number Information
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NPI Number | 1710389515
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Entity Type | Individual
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Provider Name | IASIA WELLS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 2212 HOPE MILLS RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4228
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Country | US
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Telephone | 910-779-0454
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Fax | 910-491-0833
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Provider Business Mailing Address
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Address Line | 28021 PEACH ORCHARD RD
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City | WAGRAM
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State | NC
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Zip | 28396-9229
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Country | US
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Telephone | 910-318-5601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010320
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License Number State | NC
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