Provider Demographics
NPI:1073884557
Name:SWINK, HOLLIS STEPHEN (MA, ICCS, LCPC, CAAD)
Entity Type:Individual
Prefix:MR
First Name:HOLLIS
Middle Name:STEPHEN
Last Name:SWINK
Suffix:
Gender:M
Credentials:MA, ICCS, LCPC, CAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6133
Mailing Address - Country:US
Mailing Address - Phone:217-228-0126
Mailing Address - Fax:
Practice Address - Street 1:1101 STATE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4958
Practice Address - Country:US
Practice Address - Phone:217-228-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14592101YA0400X
IL180-003697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)