Provider Demographics
NPI:1154868750
Name:WELLS, LASONDA (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:LASONDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WOODSTONE DR W APT 301
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2547
Mailing Address - Country:US
Mailing Address - Phone:269-873-3393
Mailing Address - Fax:
Practice Address - Street 1:2031 RAMBLING RD STE 7
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1632
Practice Address - Country:US
Practice Address - Phone:269-224-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional