Healthcare Provider Details

I. General information

NPI: 1134440860
Provider Name (Legal Business Name): SUSAN MAXWELL SWAN EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 BATTLE CREEK RD
HORSE SHOE NC
28742-4726
US

IV. Provider business mailing address

1875 BATTLE CREEK RD
HORSE SHOE NC
28742-4726
US

V. Phone/Fax

Practice location:
  • Phone: 828-388-1875
  • Fax:
Mailing address:
  • Phone: 828-388-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNCLPC 1011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: