Provider Demographics
NPI:1790725547
Name:NIRODI, SWATI A (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:A
Last Name:NIRODI
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 JN PEASE PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4558
Mailing Address - Country:US
Mailing Address - Phone:704-455-7878
Mailing Address - Fax:704-510-1902
Practice Address - Street 1:1909 JN PEASE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4558
Practice Address - Country:US
Practice Address - Phone:704-455-7878
Practice Address - Fax:704-510-1902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102440Medicaid