Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LEP2606 | CA |
Y | 103T00000X | Psychologist | LEP2606 | CA |
NPI | 1013062546 |
---|---|
Provider Name | Dr. Carol M Wells |
First Address | Anaheim, CA 92808-1102 |
Second Address | Anaheim, CA 92808-1102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |