Provider Demographics
NPI:1700033693
Name:ROSE WELCH, LINDA (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROSE WELCH
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 VESPER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4436
Mailing Address - Country:US
Mailing Address - Phone:207-774-3013
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3000
Practice Address - Country:US
Practice Address - Phone:207-749-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC53895101YA0400X
MELC3364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)