Provider Demographics
NPI:1699756817
Name:VELLO, WENDY LEE (LCSW, LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:VELLO
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LEE
Other - Last Name:WESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2471 LOUISVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802
Mailing Address - Country:US
Mailing Address - Phone:706-804-0006
Mailing Address - Fax:
Practice Address - Street 1:427 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-804-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63661041C0700X
GA0042011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1699756817OtherNPI