Provider Demographics
NPI:1588348700
Name:WELCH, ELIZABETH JOSEPH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOSEPH
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 LOMBARDY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2400
Mailing Address - Country:US
Mailing Address - Phone:609-668-3285
Mailing Address - Fax:
Practice Address - Street 1:1703 BELLE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6725
Practice Address - Country:US
Practice Address - Phone:609-668-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004301101YP2500X
VA0701012426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional