Provider Demographics
NPI:1699508226
Name:WELCH-DIONNE, JEANETTE (LCSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:WELCH-DIONNE
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 1:4328 RHONDA RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2849
Mailing Address - Country:US
Mailing Address - Phone:850-324-3172
Mailing Address - Fax:
Practice Address - Street 1:17 W MAXWELL ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1717
Practice Address - Country:US
Practice Address - Phone:850-324-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW198321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical