Healthcare Provider Details

I. General information

NPI: 1306148051
Provider Name (Legal Business Name): MELISSA SWARTZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E BURR BLVD
KEARNEYSVILLE WV
25430
US

IV. Provider business mailing address

150 E BURR BLVD
KEARNEYSVILLE WV
25430-4793
US

V. Phone/Fax

Practice location:
  • Phone: 681-255-2163
  • Fax: 304-555-3743
Mailing address:
  • Phone: 681-252-1632
  • Fax: 304-555-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP3505
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: