| NPI | 1679629117 |
|---|---|
| Former Name | CAROLYN THERESA WELLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 04816) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 04816) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-03-24 |