Provider Demographics
NPI:1053800995
Name:SWINNERTON, SUSAN GRACE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GRACE
Last Name:SWINNERTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:GRACE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1753 RINGLING BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6874
Mailing Address - Country:US
Mailing Address - Phone:941-366-2224
Mailing Address - Fax:941-366-2982
Practice Address - Street 1:1753 RINGLING BOULEVARD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-366-2224
Practice Address - Fax:941-366-2982
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health