Provider Demographics
NPI:1578062287
Name:SWAN, WESLEY (LCMHC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:SWAN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 NEW GARDEN RD STE 1131
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2001
Mailing Address - Country:US
Mailing Address - Phone:919-521-7288
Mailing Address - Fax:
Practice Address - Street 1:510 N ELAM AVE STE 302
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-832-1368
Practice Address - Fax:336-832-1369
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health