Individual
MARY J. WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LCP
Contact information
Practice address
11958 W BROAD ST, HENRICO, VA 23233
(804) 360-4669
(804) 364-6521
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001817
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082546
SENTARA BEHAVIORAL
VA
01
—
190033
COMPSYCH
VA
01
—
191723
HEALTHKEEPERS
VA
01
—
198317000
MAGELLAN
VA
01
—
31705
VALUE OPTIONS
VA
01
—
341259
UBH
VA
01
—
356101
PHCS
VA
01
—
381756
ANTHEM
VA
01
—
4529892
AETNA
VA
01
—
611681
OPTIMUM CHOICE
VA
Enumeration date
09/16/2006
Last updated
05/25/2018
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