Provider Demographics
NPI:1134440860
Name:SWAN, SUSAN MAXWELL (EDS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAXWELL
Last Name:SWAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 BATTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-4726
Mailing Address - Country:US
Mailing Address - Phone:828-388-1875
Mailing Address - Fax:
Practice Address - Street 1:1875 BATTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-4726
Practice Address - Country:US
Practice Address - Phone:828-388-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCLPC 1011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC52144OtherBLUE SHIELD