Organization
FAMILY SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRANCE WELLS M.ED AND LPC-I (EXECUTIVE DIRECTOR)
(803) 774-4377
Entity
Organization
Contact information
Practice address
130 BROAD ST, SUITE B, SUMTER, SC 29150-4237
(803) 774-4377
(803) 774-4378
Mailing address
130 BROAD ST, SUITE B, SUMTER, SC 29150-4237
(803) 774-4377
(803) 774-4378
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9114
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4365
—
SC
Enumeration date
02/07/2008
Last updated
02/07/2008
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