Provider Demographics
NPI:1649282260
Name:SWANSON, AUDRA A (MA ED, LPCC-S, LICDC)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA ED, LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 BELDEN VILLAGE ST NW STE 606
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2552
Mailing Address - Country:US
Mailing Address - Phone:330-305-9696
Mailing Address - Fax:303-059-2923
Practice Address - Street 1:4450 BELDEN VILLAGE ST NW STE 606
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2552
Practice Address - Country:US
Practice Address - Phone:330-305-9696
Practice Address - Fax:330-305-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2055101YP2500X
991462- LICDC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1265743991OtherNPI