Provider Demographics
NPI:1982122404
Name:SWONGER, ANGELA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:SWONGER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1846
Mailing Address - Country:US
Mailing Address - Phone:419-343-2826
Mailing Address - Fax:
Practice Address - Street 1:3330 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2425
Practice Address - Country:US
Practice Address - Phone:419-242-9955
Practice Address - Fax:419-242-8855
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1700657OtherLPC
OH1982122404Medicaid