Provider Demographics
NPI:1962471375
Name:SWIFT, RICHARD LYNN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LYNN
Last Name:SWIFT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3715 N VALDOSTA RD
Mailing Address - Street 2:#86
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1083
Mailing Address - Country:US
Mailing Address - Phone:214-415-4220
Mailing Address - Fax:220-257-2877
Practice Address - Street 1:347 MDOS/SGOMHF
Practice Address - Street 2:
Practice Address - City:MOODY AIR FORCE BASE
Practice Address - State:GA
Practice Address - Zip Code:31699-1500
Practice Address - Country:US
Practice Address - Phone:229-257-4805
Practice Address - Fax:229-257-2877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical