Provider Demographics
NPI:1992171474
Name:WELLS, KATHRYN P (CAGS MA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:P
Last Name:WELLS
Suffix:
Gender:
Credentials:CAGS MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4517
Mailing Address - Country:US
Mailing Address - Phone:703-942-9745
Mailing Address - Fax:757-585-4466
Practice Address - Street 1:256 N WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4517
Practice Address - Country:US
Practice Address - Phone:703-942-9745
Practice Address - Fax:757-585-4466
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000304103TS0200X
NJ968032103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool