Provider Demographics
NPI:1124724273
Name:WELLBOCK, KAITLYN VERONICA
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:VERONICA
Last Name:WELLBOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DUNDAS CIR STE G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1645
Mailing Address - Country:US
Mailing Address - Phone:434-326-7332
Mailing Address - Fax:
Practice Address - Street 1:7 DUNDAS CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1661
Practice Address - Country:US
Practice Address - Phone:434-326-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health