Provider Demographics
NPI:1518348788
Name:AMY SWAIM COUNSELING SERVICES INC.
Entity Type:Organization
Organization Name:AMY SWAIM COUNSELING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-830-2072
Mailing Address - Street 1:5613 DURALEIGH RD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2694
Mailing Address - Country:US
Mailing Address - Phone:919-784-0205
Mailing Address - Fax:919-784-0250
Practice Address - Street 1:5613 DURALEIGH RD
Practice Address - Street 2:SUITE 161
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:919-784-0205
Practice Address - Fax:919-784-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002437Medicaid