Basic Information
| Provider Information | |||||||||
| NPI: | 1003404088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | REESE | ||||||||
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| Credential: | LCMHC, NCC, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 YOUNGS COVE RD | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287159312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368177713 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 YOUNGS COVE RD | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287159312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287823304 | ||||||||
| FaxNumber: | 8285441201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2021 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 16114 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.