Provider Demographics
NPI:1144407628
Name:SWANN, DAVID RANDOLPH (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RANDOLPH
Last Name:SWANN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8501
Mailing Address - Country:US
Mailing Address - Phone:336-386-9801
Mailing Address - Fax:
Practice Address - Street 1:118 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8501
Practice Address - Country:US
Practice Address - Phone:336-386-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health