Provider Demographics
NPI:1548883325
Name:WELLS, GLORIA SHADELL (LCMHC)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:SHADELL
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1861
Mailing Address - Country:US
Mailing Address - Phone:910-286-0939
Mailing Address - Fax:
Practice Address - Street 1:1200 MURCHISON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4252
Practice Address - Country:US
Practice Address - Phone:910-672-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health