Provider Demographics
NPI:1588375315
Name:SWANDOL, DERRICK (LMSW)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:SWANDOL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2668
Mailing Address - Country:US
Mailing Address - Phone:240-362-7588
Mailing Address - Fax:240-362-7633
Practice Address - Street 1:10700 LESLIE LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2668
Practice Address - Country:US
Practice Address - Phone:240-362-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health