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General NPI Number Information
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NPI Number | 1629626031
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Entity Type | Individual
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Provider Name | PAIGE SWANSON
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 729 N BISHOP AVE
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City | DALLAS
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State | TX
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Zip | 75208-4340
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Country | US
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Telephone | 210-478-7567
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Fax |
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Provider Business Mailing Address
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Address Line | 4514 COLE AVE # 601
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City | DALLAS
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State | TX
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Zip | 75205-5412
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Country | US
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Telephone | 210-478-7567
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88666
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License Number State | TX
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