Provider Demographics
NPI:1598197170
Name:SWINTECK, KATHRYN DIANNE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANNE
Last Name:SWINTECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ALSTON BLVD STE C
Mailing Address - Street 2:#505
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7002
Mailing Address - Country:US
Mailing Address - Phone:919-809-5887
Mailing Address - Fax:
Practice Address - Street 1:6436 S QUEBEC ST STE 110C
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-7608
Practice Address - Country:US
Practice Address - Phone:720-590-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134424101YM0800X
CO0016477101YM0800X
ORC7632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional