Provider Demographics
NPI:1538743885
Name:WELLS, ANDRE SR
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:WELLS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 KRISTY LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5041
Mailing Address - Country:US
Mailing Address - Phone:215-756-1422
Mailing Address - Fax:
Practice Address - Street 1:227 KRISTY LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5041
Practice Address - Country:US
Practice Address - Phone:215-756-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician