Provider Demographics
NPI:1881303402
Name:SWARTZ, DIRK (SUDP)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 BAYVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-8365
Mailing Address - Country:US
Mailing Address - Phone:509-475-4709
Mailing Address - Fax:
Practice Address - Street 1:477 BAYVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-8365
Practice Address - Country:US
Practice Address - Phone:509-475-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60989688OtherWASHINGTON STATE DEPARTMENT OF HEALTH