Healthcare Provider Details

I. General information

NPI: 1790052769
Provider Name (Legal Business Name): DENISE SWISHER MSW, CADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 JAMES WAY
MCCLELLAN CA
95652-2415
US

IV. Provider business mailing address

3241 JAMES WAY
MCCLELLAN CA
95652-2415
US

V. Phone/Fax

Practice location:
  • Phone: 916-437-9100
  • Fax: 916-583-7399
Mailing address:
  • Phone: 916-437-9100
  • Fax: 916-583-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: