Healthcare Provider Details

I. General information

NPI: 1245702786
Provider Name (Legal Business Name): SWAN COUNSELING AND COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 WALESKA RD
CANTON GA
30114-2441
US

IV. Provider business mailing address

1827 POWERS FERRY RD SE BLDG 22
ATLANTA GA
30339-5621
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MOODY
Title or Position: PROVIDER
Credential: LCSW
Phone: 770-953-4744