Provider Demographics
NPI:1235271503
Name:SWAN, KAMBI ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KAMBI
Middle Name:ANN
Last Name:SWAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TREEBARK RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1234
Mailing Address - Country:US
Mailing Address - Phone:704-437-1079
Mailing Address - Fax:704-870-3312
Practice Address - Street 1:1210 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3512
Practice Address - Country:US
Practice Address - Phone:704-437-1079
Practice Address - Fax:704-870-3122
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139TWOtherBCBS
NC11612989OtherCAQH NUMBER
NC6102677Medicaid
NCE3125OtherMEDCOST