Provider Demographics
NPI:1073829669
Name:SWAINE, RICHARD MICHAEL (MA LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:SWAINE
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1110
Mailing Address - Country:US
Mailing Address - Phone:757-345-5802
Mailing Address - Fax:757-345-5725
Practice Address - Street 1:354 MCLAWS CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6346
Practice Address - Country:US
Practice Address - Phone:757-345-5802
Practice Address - Fax:757-345-5725
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health