Provider Demographics
NPI:1386692911
Name:WELLS, VICKI LYNNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PONDEROSA DR
Mailing Address - Street 2:STE D
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073
Mailing Address - Country:US
Mailing Address - Phone:540-382-1494
Mailing Address - Fax:540-382-3039
Practice Address - Street 1:120 PONDEROSA DR
Practice Address - Street 2:STE D
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-382-1494
Practice Address - Fax:540-382-3039
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003566101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA142924OtherANTHEM
VA521541OtherVALUE OPTIONS