Provider Demographics
NPI:1396100350
Name:WELLS, JAMES CHARLES JEROME (EDS,NCC,LPC-S,CSAT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES JEROME
Last Name:WELLS
Suffix:
Gender:M
Credentials:EDS,NCC,LPC-S,CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SOUTHBRIDGE PKWY
Mailing Address - Street 2:SUITE 650
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1302
Mailing Address - Country:US
Mailing Address - Phone:205-414-7426
Mailing Address - Fax:877-308-8259
Practice Address - Street 1:2100 SOUTHBRIDGE PKWY
Practice Address - Street 2:SUITE 650
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1302
Practice Address - Country:US
Practice Address - Phone:205-414-7426
Practice Address - Fax:877-308-8259
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2948101Y00000X
101YA0400X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist