Healthcare Provider Details

I. General information

NPI: 1629631619
Provider Name (Legal Business Name): SETH SWOOPE LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 INDIA HOOK RD STE 104&105
ROCK HILL SC
29732-3530
US

IV. Provider business mailing address

50 PARKWOOD CT
CAMDEN SC
29020-1666
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-6250
  • Fax: 615-577-5654
Mailing address:
  • Phone: 803-493-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28775
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: