Provider Demographics
NPI:1104403617
Name:HARRIS-SWAN, CAMERON (LGPC)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:
Last Name:HARRIS-SWAN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 KREFELD LANE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5358
Mailing Address - Country:US
Mailing Address - Phone:301-887-7269
Mailing Address - Fax:
Practice Address - Street 1:1208 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3442
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health