Provider Demographics
NPI:1417226622
Name:WELLS, TAMICA M (LCSW)
Entity type:Individual
Prefix:
First Name:TAMICA
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 CONWAY PLACE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-4297
Mailing Address - Country:US
Mailing Address - Phone:240-370-9076
Mailing Address - Fax:
Practice Address - Street 1:11177 CONWAY PLACE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-4297
Practice Address - Country:US
Practice Address - Phone:240-370-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1417226622Medicaid