Provider Demographics
NPI:1831299189
Name:SWARTZENTRUBER, MERLIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MERLIN
Middle Name:
Last Name:SWARTZENTRUBER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 MORRIS NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23457-1322
Mailing Address - Country:US
Mailing Address - Phone:757-426-5225
Mailing Address - Fax:
Practice Address - Street 1:RESTORER OF BROKEN WALLS
Practice Address - Street 2:2697 INTERNATIONAL PKWY, PARKWAY TWO, STE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-547-1811
Practice Address - Fax:757-547-1118
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861562472Medicaid