Provider Demographics
NPI:1821505678
Name:WELCH, OVISTON (LCAS-A ; RMHCI)
Entity Type:Individual
Prefix:
First Name:OVISTON
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:LCAS-A ; RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4916
Mailing Address - Country:US
Mailing Address - Phone:813-236-1182
Mailing Address - Fax:
Practice Address - Street 1:2101 GARNER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-0114
Practice Address - Country:US
Practice Address - Phone:919-832-4453
Practice Address - Fax:919-829-1357
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS24107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)