MEDICARE: KEVIN W WELLS MA, CACI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	12053115	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12053115	OTHER	SC	MA, CACI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891988192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN W WELLS MA, CACI

Provider Business Mailing Address
First Line	:	187 W BROAD ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3234
Country	:	US
Telephone Number	:	864-582-7588
Fax Number	:	864-582-0431

Provider Business Practice Location Address
First Line	:	187 W BROAD ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3234
Country	:	US
Telephone Number	:	864-582-7588
Fax Number	:	864-582-0431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	01/31/2013

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