Healthcare Provider Details

I. General information

NPI: 1083633978
Provider Name (Legal Business Name): ROBERT SWAY L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY WINN WAY MENTAL HEALTH CENTER
DECATUR GA
30030
US

IV. Provider business mailing address

205 S COLUMBIA DR
DECATUR GA
30030-4106
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7700
  • Fax:
Mailing address:
  • Phone: 404-377-8520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002780
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: