Provider Demographics
NPI:1053844167
Name:WELLS, CHRISTIANA
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6804 PLANTING ST APT 6306
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8730
Mailing Address - Country:US
Mailing Address - Phone:407-797-0672
Mailing Address - Fax:
Practice Address - Street 1:13650 W COLONIAL DR STE 150
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3994
Practice Address - Country:US
Practice Address - Phone:302-334-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician