Provider Demographics
NPI:1326179599
Name:SWABY, SANDE NICKEISHA (LADC INTENT)
Entity Type:Individual
Prefix:MISS
First Name:SANDE
Middle Name:NICKEISHA
Last Name:SWABY
Suffix:
Gender:F
Credentials:LADC INTENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CHALMETTE DR APT B
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2880
Mailing Address - Country:US
Mailing Address - Phone:405-524-1076
Mailing Address - Fax:
Practice Address - Street 1:2701 N OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2724
Practice Address - Country:US
Practice Address - Phone:405-552-8868
Practice Address - Fax:405-528-8692
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)