Provider Demographics
NPI:1356445944
Name:SWAYZE, CORNELIA H (LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:H
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3436
Mailing Address - Country:US
Mailing Address - Phone:228-363-2211
Mailing Address - Fax:228-255-6494
Practice Address - Street 1:4387 LEISURE TIME DRIVE
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525
Practice Address - Country:US
Practice Address - Phone:228-363-2211
Practice Address - Fax:228-255-6494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC46481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical