| Well America Inc. | |
|
4030 Wake Forest Rd Ste 349 Raleigh NC 27609-0010 | |
| (732) 485-1301 | |
| Not Available |
| Full Name | Well America Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 4030 Wake Forest Rd Ste 349, Raleigh, North Carolina |
| Authorized Official Name and Position | Yasir J. Ahmad (OWNER) |
| Authorized Official Contact | 7324851301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well America Inc. 79 Ogle Rd Old Tappan NJ 07675-7026 Ph: (732) 485-1301 | Well America Inc. 4030 Wake Forest Rd Ste 349 Raleigh NC 27609-0010 Ph: (732) 485-1301 |
| NPI Number | 1053074765 |
|---|---|
| Provider Enumeration Date | 10/19/2021 |
| Last Update Date | 10/19/2021 |
| Certification Date | 10/19/2021 |
| Medicare PECOS PAC ID | 8628461233 |
|---|---|
| Medicare Enrollment ID | O20220203000318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053074765 | NPI | - | NPPES |
| PENDING | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Courtney Tierra Keith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770093452 PECOS PAC ID: 6901201607 Enrollment ID: I20210818002205 |
| Provider Name | Adrian Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811495120 PECOS PAC ID: 4082011820 Enrollment ID: I20220203000446 |
| Provider Name | Demetric Marsh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629190848 PECOS PAC ID: 9638270226 Enrollment ID: I20220315000948 |
| Provider Name | Lauren Morton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871220442 PECOS PAC ID: 5799161782 Enrollment ID: I20220928001851 |
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