Provider Demographics
NPI:1972018430
Name:WELSCH, CHRISTINE A
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:WELSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BRAZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5724 S TOWNSHIP ROAD 13
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807-9757
Mailing Address - Country:US
Mailing Address - Phone:567-224-7629
Mailing Address - Fax:
Practice Address - Street 1:34 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:567-560-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.167725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator