Provider Demographics
NPI:1578608139
Name:SWAYNE, DON W (BSW, MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:W
Last Name:SWAYNE
Suffix:
Gender:M
Credentials:BSW, MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 UNITED ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1311
Mailing Address - Country:US
Mailing Address - Phone:336-337-2963
Mailing Address - Fax:
Practice Address - Street 1:4309 UNITED ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1311
Practice Address - Country:US
Practice Address - Phone:336-337-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002983Medicaid
NC2876867Medicare ID - Type Unspecified