Provider Demographics
NPI:1063203909
Name:WELLS, DARLENE LAVETTE (CERTIFIED DSP)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:LAVETTE
Last Name:WELLS
Suffix:
Gender:F
Credentials:CERTIFIED DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2463
Mailing Address - Country:US
Mailing Address - Phone:419-810-9122
Mailing Address - Fax:
Practice Address - Street 1:548 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2463
Practice Address - Country:US
Practice Address - Phone:419-810-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities