Provider Demographics
NPI:1972844934
Name:SWAIN, TINA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15211 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2818
Mailing Address - Country:US
Mailing Address - Phone:708-790-1457
Mailing Address - Fax:
Practice Address - Street 1:15211 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2818
Practice Address - Country:US
Practice Address - Phone:708-790-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional