Provider Demographics
NPI:1538691605
Name:MORELAN, ROSEMARIE (EDS)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:MORELAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 COUNTY ROAD 801
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-5211
Mailing Address - Country:US
Mailing Address - Phone:423-263-5332
Mailing Address - Fax:
Practice Address - Street 1:128 COUNTY ROAD 801
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-5211
Practice Address - Country:US
Practice Address - Phone:423-263-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000215840103TS0200X
NC1204840103TS0200X
GA669793103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool