Provider Demographics
NPI:1730252677
Name:WELLS, CAROLYN MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 TURKEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901
Mailing Address - Country:US
Mailing Address - Phone:410-287-5235
Mailing Address - Fax:410-287-2556
Practice Address - Street 1:1930 TURKEY POINT RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901
Practice Address - Country:US
Practice Address - Phone:410-287-5235
Practice Address - Fax:410-287-2556
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC00881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical