Provider Demographics
NPI:1215709217
Name:SWADINSKY, AMANDA D (LCMHCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:SWADINSKY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 MAPLECHASE LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4162
Mailing Address - Country:US
Mailing Address - Phone:309-258-5795
Mailing Address - Fax:
Practice Address - Street 1:71 KILMAYNE DR STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5568
Practice Address - Country:US
Practice Address - Phone:919-342-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health