Provider Demographics
NPI:1285906958
Name:SWANSON, CAROL A (LMFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 SUNSET LN
Mailing Address - Street 2:STE 210
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6134
Mailing Address - Country:US
Mailing Address - Phone:925-753-2156
Mailing Address - Fax:925-753-2157
Practice Address - Street 1:4710 AUTUMN MEADOW DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3994
Practice Address - Country:US
Practice Address - Phone:707-688-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285906958Medicare NSC