Provider Demographics
NPI:1679119903
Name:WELLS, LASHON POOLE (LCSW)
Entity type:Individual
Prefix:
First Name:LASHON
Middle Name:POOLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SCENIC HIGHWAY STE 266
Mailing Address - Street 2:1350 SCENIC HIGHWAY STE 266
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:678-777-6949
Mailing Address - Fax:
Practice Address - Street 1:1350 SCENIC HIGHWAY STE 266
Practice Address - Street 2:1350 SCENIC HIGHWAY STE 266
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:678-777-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0069201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical