=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801728886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEADWATERS WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 STORER ST STE 403B
-----------------------------------------------------
City | KENNEBUNK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04043-6885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-814-7387
-----------------------------------------------------
Fax | 207-200-9719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 STORER ST STE 403B
-----------------------------------------------------
City | KENNEBUNK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04043-6885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-814-7387
-----------------------------------------------------
Fax | 207-200-9719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RACHEL WELLS
-----------------------------------------------------
Credential | PHD, LCPC
-----------------------------------------------------
Telephone | 207-370-7376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------