Healthcare Provider Details

I. General information

NPI: 1306571518
Provider Name (Legal Business Name): MICHAEL LEE SWEENEY NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SWAYNE DR
MOORESVILLE NC
28117-6049
US

IV. Provider business mailing address

125 SWAYNE DR
MOORESVILLE NC
28117-6049
US

V. Phone/Fax

Practice location:
  • Phone: 828-268-8643
  • Fax:
Mailing address:
  • Phone: 828-268-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3631771
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: