Provider Demographics
NPI:1568773604
Name:SWINNEY, GRADY NOEL (DDIV, CPC, CLC)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:NOEL
Last Name:SWINNEY
Suffix:
Gender:M
Credentials:DDIV, CPC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E STONE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5654
Mailing Address - Country:US
Mailing Address - Phone:864-316-7613
Mailing Address - Fax:
Practice Address - Street 1:209 E STONE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5654
Practice Address - Country:US
Practice Address - Phone:864-316-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral