Provider Demographics
NPI:1659934164
Name:MCSWAIN, VIRGINIA DENISE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DENISE
Last Name:MCSWAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4435
Mailing Address - Country:US
Mailing Address - Phone:610-541-0766
Mailing Address - Fax:
Practice Address - Street 1:220 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3644
Practice Address - Country:US
Practice Address - Phone:619-795-7232
Practice Address - Fax:619-795-7256
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1339800319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)