Provider Demographics
NPI:1356675599
Name:SWANAGAN, LONNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:SWANAGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W LA RUA ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3633
Mailing Address - Country:US
Mailing Address - Phone:850-529-6264
Mailing Address - Fax:850-696-2347
Practice Address - Street 1:1508 W LA RUA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3633
Practice Address - Country:US
Practice Address - Phone:850-529-6264
Practice Address - Fax:850-696-2347
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW94131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical