Provider Demographics
NPI:1063565596
Name:WELLS, CAROL (LISW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0654
Mailing Address - Country:US
Mailing Address - Phone:575-770-2415
Mailing Address - Fax:575-758-3471
Practice Address - Street 1:205 LUND ST.
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6294
Practice Address - Country:US
Practice Address - Phone:575-770-2415
Practice Address - Fax:575-758-3471
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-34771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical