Provider Demographics
NPI:1285770818
Name:WELLS, JAMES D JR (LCMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ELROSA RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5778
Mailing Address - Country:US
Mailing Address - Phone:704-840-7005
Mailing Address - Fax:704-360-2298
Practice Address - Street 1:122 ELROSA RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-5778
Practice Address - Country:US
Practice Address - Phone:704-840-7005
Practice Address - Fax:704-360-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10150101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285770818Medicaid