Provider Demographics
NPI:1659570844
Name:SWANSTROM, NOVA ANNMAY (LPA)
Entity Type:Individual
Prefix:
First Name:NOVA
Middle Name:ANNMAY
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TRADD CT
Mailing Address - Street 2:DELTA BEHAVIORAL HEALTH
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6637
Mailing Address - Country:US
Mailing Address - Phone:910-343-6890
Mailing Address - Fax:910-332-1233
Practice Address - Street 1:1920 TRADD CT
Practice Address - Street 2:DELTA BEHAVIORAL HEALTH
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6637
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:910-332-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist