Healthcare Provider Details

I. General information

NPI: 1962948554
Provider Name (Legal Business Name): SWS PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6778 EXECUTIVE OAK LN
CHATTANOOGA TN
37421-1970
US

IV. Provider business mailing address

PO BOX 247
HIXSON TN
37343-0247
US

V. Phone/Fax

Practice location:
  • Phone: 423-805-2514
  • Fax: 423-531-2487
Mailing address:
  • Phone: 423-805-2514
  • Fax: 423-531-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6443
License Number StateTN

VIII. Authorized Official

Name: MR. RICHARD STEVEN MCDONALD JR.
Title or Position: REGISTERED AGENT
Credential: L.C.S.W.
Phone: 423-509-8765