Healthcare Provider Details

I. General information

NPI: 1376026559
Provider Name (Legal Business Name): DEBRA JOY FRUMP SWA, CTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA JOY MAHAN SWA, CTP

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 N SOUTH ST
WILMINGTON OH
45177-1649
US

IV. Provider business mailing address

232 N SOUTH ST
WILMINGTON OH
45177-1649
US

V. Phone/Fax

Practice location:
  • Phone: 937-414-2016
  • Fax: 937-366-6814
Mailing address:
  • Phone: 937-414-2016
  • Fax: 937-366-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW1400027
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168408
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: