Provider Demographics
NPI:1770672743
Name:SWANBERG, GEORGE LYNDON (LCSW, LSATP, MAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LYNDON
Last Name:SWANBERG
Suffix:
Gender:M
Credentials:LCSW, LSATP, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTON
Mailing Address - State:VA
Mailing Address - Zip Code:22724-2001
Mailing Address - Country:US
Mailing Address - Phone:540-347-9531
Mailing Address - Fax:703-691-7410
Practice Address - Street 1:4308 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTON
Practice Address - State:VA
Practice Address - Zip Code:22724-2001
Practice Address - Country:US
Practice Address - Phone:540-347-9531
Practice Address - Fax:703-691-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000188101YA0400X
VA09040062651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical