Provider Demographics
NPI:1689745713
Name:SWAN, MARA (LCPC LCPAT)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:LCPC LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GATEWAY DR
Mailing Address - Street 2:SUITE 3-4B
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4268
Mailing Address - Country:US
Mailing Address - Phone:410-838-9558
Mailing Address - Fax:410-838-9599
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:SUITE 3-4B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:410-838-9558
Practice Address - Fax:410-838-9599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1986101YP2500X
MDATC009221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist