Provider Demographics
NPI:1104515873
Name:RAQUEL WELLS, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:RAQUEL WELLS, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-535-8660
Mailing Address - Street 1:200 S MAIN ST # 100-535
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4284
Mailing Address - Country:US
Mailing Address - Phone:707-503-0569
Mailing Address - Fax:707-261-1258
Practice Address - Street 1:120 PLEASANT HILL AVE N STE 200Q
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3167
Practice Address - Country:US
Practice Address - Phone:415-294-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAQUEL WELLS, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-08
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)