Organization
WELLSTAR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY C LU (CREDENTIALING MANAGER)
(904) 221-2535
Entity
Organization
Contact information
Practice address
4217 BAYMEADOWS RD STE 2, JACKSONVILLE, FL 32217-4676
(904) 332-7431
(904) 332-7408
Mailing address
4217 BAYMEADOWS RD STE 2, JACKSONVILLE, FL 32217-4676
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
08/28/2017
Last updated
08/28/2017
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