Provider Demographics
NPI:1770393514
Name:SWINNEA, JESSICA LEIGH (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SWINNEA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2235
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7235
Mailing Address - Country:US
Mailing Address - Phone:903-203-9324
Mailing Address - Fax:
Practice Address - Street 1:600 S PALESTINE ST STE 201
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3323
Practice Address - Country:US
Practice Address - Phone:903-203-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical