Provider Demographics
NPI:1215786553
Name:WELLS, BIANCA MERCEDES (LMSW)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MERCEDES
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 S ELLIS ST APT 3020
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4974
Mailing Address - Country:US
Mailing Address - Phone:623-261-7983
Mailing Address - Fax:
Practice Address - Street 1:3377 S PRICE RD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3573
Practice Address - Country:US
Practice Address - Phone:480-252-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty