Provider Demographics
NPI:1669118410
Name:BELLANCA, CHRISTA WELCH (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:WELCH
Last Name:BELLANCA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 OAK DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-3035
Mailing Address - Country:US
Mailing Address - Phone:301-615-1117
Mailing Address - Fax:
Practice Address - Street 1:2009 TIDEWATER COLONY DR STE B
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2107
Practice Address - Country:US
Practice Address - Phone:301-615-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD229871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical