Healthcare Provider Details

I. General information

NPI: 1902906407
Provider Name (Legal Business Name): ERIN K. SWENSON TH.M., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIC K. SWENSON MFT

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 AUBURN AVE NE APT 258
ATLANTA GA
30312-1981
US

IV. Provider business mailing address

659 AUBURN AVE NE APT 258
ATLANTA GA
30312-1981
US

V. Phone/Fax

Practice location:
  • Phone: 404-312-5677
  • Fax: 404-565-2633
Mailing address:
  • Phone: 404-312-5677
  • Fax: 404-565-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000455
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: