Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | GA | |
Y | 101YP2500X | Professional Counselor | LPC005943 | GA |
NPI | 1235535253 |
---|---|
Provider Name | Dr. Reginald Lamar Wells |
First Address | Atlanta, GA 30312-2900 |
Second Address | Atlanta, GA 30312-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003189469A | (05) | GA |