Individual
LARRY WELLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 GARNER ST W, WILSON, NC 27893-2835
(252) 237-4242
(252) 237-8917
Mailing address
410 GARNER ST W, P.O. BOX 694, WILSON, NC 27893-2835
(252) 237-4242
(252) 237-8917
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
MHL098077
NC
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804567
—
NC
05
—
8301975B
—
NC
Enumeration date
03/30/2007
Last updated
06/10/2008
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