Healthcare Provider Details

I. General information

NPI: 1992990675
Provider Name (Legal Business Name): MS. TRACY MAE SWETLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 TWINBROOK PKWY
ROCKVILLE MD
20851-1400
US

IV. Provider business mailing address

751 TWINBROOK PKWY
ROCKVILLE MD
20851-1400
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-4101
  • Fax: 301-315-8331
Mailing address:
  • Phone: 301-838-4101
  • Fax: 301-315-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: