Provider Demographics
NPI:1003404088
Name:WELLS, BYRON REESE (LCMHC, NCC, MA)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:REESE
Last Name:WELLS
Suffix:
Gender:M
Credentials:LCMHC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YOUNGS COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9312
Mailing Address - Country:US
Mailing Address - Phone:336-817-7713
Mailing Address - Fax:
Practice Address - Street 1:300 YOUNGS COVE RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9312
Practice Address - Country:US
Practice Address - Phone:828-782-3304
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health