Provider Demographics
NPI:1871978361
Name:ANNELIE MCCRORIE WELCH, LCSW, BCB, LLC
Entity type:Organization
Organization Name:ANNELIE MCCRORIE WELCH, LCSW, BCB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNELIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-234-8861
Mailing Address - Street 1:10060 SKINNER LAKE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8495
Mailing Address - Country:US
Mailing Address - Phone:904-234-8861
Mailing Address - Fax:
Practice Address - Street 1:2380 3RD ST S
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4072
Practice Address - Country:US
Practice Address - Phone:904-234-8861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW57631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty