Provider Demographics
NPI:1962557140
Name:WELLSPRING COUNSELING CENTER
Entity type:Organization
Organization Name:WELLSPRING COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:334-444-4819
Mailing Address - Street 1:2813 PEPPERELL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6125
Mailing Address - Country:US
Mailing Address - Phone:334-741-8007
Mailing Address - Fax:334-741-8810
Practice Address - Street 1:2813 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6125
Practice Address - Country:US
Practice Address - Phone:334-741-8007
Practice Address - Fax:334-741-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL197302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization