Provider Demographics
NPI:1124123229
Name:SWINGHOLM, YONNA F (LICSW)
Entity type:Individual
Prefix:
First Name:YONNA
Middle Name:F
Last Name:SWINGHOLM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORDOVA PL # 315
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1725
Mailing Address - Country:US
Mailing Address - Phone:206-457-7223
Mailing Address - Fax:
Practice Address - Street 1:2018 FORT BRAGG RD STE 104B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:206-457-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000080051041C0700X
CALCSW683671041C0700X
NMC-114221041C0700X
NCC0119721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical