Provider Demographics
NPI:1700379096
Name:SWANSON, TERRENCE (CADC II)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W HARRISON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-5805
Mailing Address - Country:US
Mailing Address - Phone:805-653-2596
Mailing Address - Fax:805-648-9762
Practice Address - Street 1:125 W HARRISON AVE APT A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-653-2596
Practice Address - Fax:805-648-9762
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII059410618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)