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General NPI Number Information
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NPI Number | 1558937573
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Entity Type | Individual
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Provider Name | JACQUELINE SWAIN
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Gender | Female
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 3020 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5246
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Country | US
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Telephone | 910-218-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 QUARTERS LANDING CIR APT 717
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City | SNEADS FERRY
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State | NC
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Zip | 28460-8099
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Country | US
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Telephone | 910-261-3444
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-14693
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 3037
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License Number State | NC
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