Healthcare Provider Details

I. General information

NPI: 1811806557
Provider Name (Legal Business Name): LACI AYANNA WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6026 SWANSON CREEK LN
HUGHESVILLE MD
20637-2807
US

IV. Provider business mailing address

6026 SWANSON CREEK LN
HUGHESVILLE MD
20637-2807
US

V. Phone/Fax

Practice location:
  • Phone: 301-266-3105
  • Fax:
Mailing address:
  • Phone: 301-266-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB10322075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: