Provider Demographics
NPI:1053146258
Name:SWANSON, CAROLYN FAYE (MS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 HIGHLAND MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6200
Mailing Address - Country:US
Mailing Address - Phone:804-405-2793
Mailing Address - Fax:
Practice Address - Street 1:2717 GRAND MEADOWS CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2174
Practice Address - Country:US
Practice Address - Phone:804-497-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health