Individual
WILLIE JOHNATHAN WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
6857 COBBLESTONE BLVD, SOUTHAVEN, MS 38672-9312
(662) 253-8040
(662) 470-5984
Mailing address
58 TIMBER CREEK DR, CORDOVA, TN 38018-4233
(622) 253-8040
(662) 470-5984
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1976
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04539260
—
MS
05
—
Q023618
—
TN
Enumeration date
10/09/2015
Last updated
06/03/2019
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