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General NPI Number Information
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NPI Number | 1053666834
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Entity Type | Organization
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Legal Business Name | CAROLINA NEUROBEHAVIORAL SERVICE
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 7810 BALLANTYNE COMMONS PKWY SUITE 309
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City | CHARLOTTE
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State | NC
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Zip | 28277-3415
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Country | US
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Telephone | 704-319-5538
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Fax | 888-703-9409
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Provider Business Mailing Address
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Address Line | 7810 BALLANTYNE COMMONS PKWY SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-3415
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Country | US
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Telephone | 704-319-5538
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Fax | 888-703-9409
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Authorized Official
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Title or Position | OWNER/NEURPSYCHOLOGIST
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Name | DR. LISA ANNE SWOROWSKI
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Credential | PH.D.
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Telephone | 704-319-5538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4230
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4230
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License Number State | NC
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