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General NPI Number Information
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NPI Number | 1104403617
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Entity Type | Individual
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Provider Name | CAMERON HARRIS-SWAN LGPC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 1208 E CHURCHVILLE RD
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City | BEL AIR
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State | MD
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Zip | 21014-3442
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Country | US
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Telephone | 410-893-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3216 KREFELD LANE
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City | WALDORF
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State | MD
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Zip | 20603-5358
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Country | US
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Telephone | 301-887-7269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP11339
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License Number State | MD
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