Provider Demographics
NPI:1306425160
Name:WELLS, PAMELA RENEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:RENEE
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 1:306 BENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4801
Mailing Address - Country:US
Mailing Address - Phone:202-604-0838
Mailing Address - Fax:
Practice Address - Street 1:9500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3701
Practice Address - Country:US
Practice Address - Phone:301-276-2606
Practice Address - Fax:240-823-9331
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD191001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical