Provider Demographics
NPI:1033650494
Name:WELSH, ROANNE E (LMBT, CNMT)
Entity Type:Individual
Prefix:
First Name:ROANNE
Middle Name:E
Last Name:WELSH
Suffix:
Gender:F
Credentials:LMBT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 E LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9370
Mailing Address - Country:US
Mailing Address - Phone:828-777-6665
Mailing Address - Fax:
Practice Address - Street 1:514 5TH AVE W
Practice Address - Street 2:SUITE# 102
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4204
Practice Address - Country:US
Practice Address - Phone:828-777-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist