Provider Demographics
NPI:1497629380
Name:WELLS MCMANUS, TAKIYA (LMSW)
Entity type:Individual
Prefix:
First Name:TAKIYA
Middle Name:
Last Name:WELLS MCMANUS
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 1:7863 HIDDEN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:STONEY BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7863 HIDDEN CREEK WAY
Practice Address - Street 2:
Practice Address - City:STONEY BEACH
Practice Address - State:MD
Practice Address - Zip Code:21226-2120
Practice Address - Country:US
Practice Address - Phone:301-300-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21224104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty