Individual
JACYNTHIA SWANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 MORSON ST STE A, RALEIGH, NC 27601-1559
(919) 607-2044
Mailing address
405 MORSON ST STE A, RALEIGH, NC 27601-1559
(919) 607-2044
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
NC
172V00000X
Community Health Worker
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
900780474
—
NC
Enumeration date
12/20/2011
Last updated
12/20/2011
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