Basic Information
| Provider Information | |||||||||
| NPI: | 1548356033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | JO ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RASI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 J STREET | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163255556 | ||||||||
| FaxNumber: | 9164405620 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 J STREET | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163255556 | ||||||||
| FaxNumber: | 9164405620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 101YA04000X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.