Provider Demographics
NPI:1992939201
Name:WELLPSYCHE, INC.
Entity type:Organization
Organization Name:WELLPSYCHE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-232-8330
Mailing Address - Street 1:501 BROAD ST STE 306
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3096
Mailing Address - Country:US
Mailing Address - Phone:706-232-8330
Mailing Address - Fax:844-873-4760
Practice Address - Street 1:501 BROAD ST STE 306
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3096
Practice Address - Country:US
Practice Address - Phone:706-232-8330
Practice Address - Fax:844-873-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA434425435DMedicaid
GA511I680018Medicare UPIN