Basic Information
| Provider Information | |||||||||
| NPI: | 1679939037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | QMHP | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | SUITE 302 PO BOX 7400 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037710170 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | SUITE 302 PO | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037710170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.