MEDICARE: AFTON WELCH MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC001986	GA

General Provider Information

NPI Number	:	1396102000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFTON WELCH MA, LPC

Provider Business Mailing Address
First Line	:	970 PEACHTREE INDUSTRIAL BLVD
Second Line	:	SUITE 100
City	:	SUWANEE
State	:	GA
Zip	:	30024-6988
Country	:	US
Telephone Number	:	925-768-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 AVONLEY CREEK DR
Second Line	:	SUGAR HILL
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-7296
Country	:	US
Telephone Number	:	925-768-5139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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