Provider Demographics
NPI:1104169341
Name:SWAYNE, MONICA A (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:SWAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6643
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6643
Mailing Address - Country:US
Mailing Address - Phone:888-561-5688
Mailing Address - Fax:877-389-1333
Practice Address - Street 1:640 PLUM STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2859
Practice Address - Country:US
Practice Address - Phone:888-561-5568
Practice Address - Fax:877-389-1333
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical