Provider Demographics
NPI:1205396934
Name:SWINNEY, CHRISTINE FONG
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:FONG
Last Name:SWINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11612 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2033
Mailing Address - Country:US
Mailing Address - Phone:402-578-5140
Mailing Address - Fax:
Practice Address - Street 1:4565 S 133RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1142
Practice Address - Country:US
Practice Address - Phone:402-590-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11297101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor