Provider Demographics
NPI:1003590068
Name:SWAFFORD, SHAWN ERIC (ALC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ERIC
Last Name:SWAFFORD
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 UNIVERSITY DR NW STE 13
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1867
Mailing Address - Country:US
Mailing Address - Phone:256-850-4091
Mailing Address - Fax:
Practice Address - Street 1:4820 UNIVERSITY DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1867
Practice Address - Country:US
Practice Address - Phone:256-850-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04401101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor