Provider Demographics
NPI:1578936019
Name:SWANSON, ERNEST (RESIDENT/COUNSELING)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:RESIDENT/COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 SAILORS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CALLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24530-3811
Mailing Address - Country:US
Mailing Address - Phone:434-713-5499
Mailing Address - Fax:
Practice Address - Street 1:629 SAILORS CREEK RD
Practice Address - Street 2:
Practice Address - City:CALLANDS
Practice Address - State:VA
Practice Address - Zip Code:24530-3811
Practice Address - Country:US
Practice Address - Phone:434-713-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor