Provider Demographics
NPI:1386146298
Name:SWAIN, SELINA MARIE (CADC III)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIE
Last Name:SWAIN
Suffix:
Gender:
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 HAMLIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1694
Mailing Address - Country:US
Mailing Address - Phone:818-305-1263
Mailing Address - Fax:
Practice Address - Street 1:14515 HAMLIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1694
Practice Address - Country:US
Practice Address - Phone:818-305-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB00002731222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL