Provider Demographics
NPI:1306286778
Name:MONICA A. SWAYNE, LCSW, LLC
Entity type:Organization
Organization Name:MONICA A. SWAYNE, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-719-6361
Mailing Address - Street 1:640 PLUM STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2859
Mailing Address - Country:US
Mailing Address - Phone:888-561-5568
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004790251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health