Basic Information
| Provider Information | |||||||||
| NPI: | 1437287463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 DOCTORS CT | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297068644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035818311 | ||||||||
| FaxNumber: | 8033297141 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 E MAIN ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297304541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033289600 | ||||||||
| FaxNumber: | 8033297141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.