Provider Demographics
NPI:1922165786
Name:SWAN, MATTHEW THOMAS (LCPC, LCPAT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SWAN
Suffix:
Gender:M
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:2007-01-02
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC009101Y00000X
MDLC2252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor