Provider Demographics
NPI:1578881538
Name:WELCH, WAYNE HARDY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:HARDY
Last Name:WELCH
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NORWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5153
Mailing Address - Country:US
Mailing Address - Phone:912-856-5658
Mailing Address - Fax:912-353-9663
Practice Address - Street 1:308 COMMERCIAL DR
Practice Address - Street 2:#100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3684
Practice Address - Country:US
Practice Address - Phone:912-856-5658
Practice Address - Fax:188-851-4702
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0010121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical