Provider Demographics
NPI:1093250524
Name:SWANSON, MINDY (LPC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 BRAELINN CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2140
Mailing Address - Country:US
Mailing Address - Phone:770-713-5858
Mailing Address - Fax:
Practice Address - Street 1:25 E BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1922
Practice Address - Country:US
Practice Address - Phone:770-988-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional