Provider Demographics
NPI:1982026282
Name:SWAN'S THERAPEUTIC SERVICES PLLC
Entity Type:Organization
Organization Name:SWAN'S THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DISHEMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHULER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-456-9907
Mailing Address - Street 1:136 MANGUM CIR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6916
Mailing Address - Country:US
Mailing Address - Phone:803-290-3081
Mailing Address - Fax:
Practice Address - Street 1:136 MANGUM CIR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6916
Practice Address - Country:US
Practice Address - Phone:803-290-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008432251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982026282Medicaid