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General NPI Number Information
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NPI Number | 1982026282
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Entity Type | Organization
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Legal Business Name | SWAN'S THERAPEUTIC SERVICES PLLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 136 MANGUM CIR
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City | MOORESVILLE
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State | NC
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Zip | 28117-6916
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Country | US
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Telephone | 803-290-3081
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Fax |
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Provider Business Mailing Address
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Address Line | 136 MANGUM CIR
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City | MOORESVILLE
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State | NC
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Zip | 28117-6916
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Country | US
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Telephone | 803-290-3081
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DISHEMA S. SHULER
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Credential | LCSW
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Telephone | 336-456-9907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C008432
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License Number State | NC
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