Healthcare Provider Details

I. General information

NPI: 1417761420
Provider Name (Legal Business Name): FELICIA SWALLOW LAC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 W MAIN ST
RAPID CITY SD
57702-2575
US

IV. Provider business mailing address

1719 W MAIN ST
RAPID CITY SD
57702-2575
US

V. Phone/Fax

Practice location:
  • Phone: 605-303-6942
  • Fax:
Mailing address:
  • Phone: 605-787-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number20777
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23091970
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: