Provider Demographics
NPI:1134442676
Name:SMITH WELLS, SARA IRENE (MA)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:IRENE
Last Name:SMITH WELLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 LAUREL OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6221
Mailing Address - Country:US
Mailing Address - Phone:910-868-1528
Mailing Address - Fax:910-433-2004
Practice Address - Street 1:1529 LAUREL OAK DR
Practice Address - Street 2:HTTPS://DOXY.ME/DISCIPLE4LIFE
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6221
Practice Address - Country:US
Practice Address - Phone:910-433-9007
Practice Address - Fax:910-433-2004
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8035101YP2500X, 101YP2500X
NC101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC169G3OtherBCBSNC
NC499148OtherTRICARE
NCS1796OtherSANDHILLS CENTER
NC499148OtherMHN
NCNC12297155 4940449OtherCIGNA
NC1134442676OtherALLIANCE BEHAVIORAL HEALTH CARE
NC2289730OtherCOMPSYCH
NC6104986Medicaid