Provider Demographics
NPI:1699829721
Name:SWAIN, LAURA C (CAC III)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:SWAIN
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S 8TH ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1829
Mailing Address - Country:US
Mailing Address - Phone:719-578-5433
Mailing Address - Fax:719-578-5434
Practice Address - Street 1:304 S 8TH ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1829
Practice Address - Country:US
Practice Address - Phone:719-578-5433
Practice Address - Fax:719-578-5434
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1483-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17157528Medicaid