Provider Demographics
NPI:1770086043
Name:SWARAY, EDWIN NYUMAH (MA, LADC, CBIS)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:NYUMAH
Last Name:SWARAY
Suffix:
Gender:M
Credentials:MA, LADC, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11112 HILLSBORO AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3128
Mailing Address - Country:US
Mailing Address - Phone:763-300-0289
Mailing Address - Fax:
Practice Address - Street 1:11112 HILLSBORO AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3128
Practice Address - Country:US
Practice Address - Phone:763-300-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303810101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)