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General NPI Number Information
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NPI Number | 1235449273
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Entity Type | Organization
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Legal Business Name | CORNELIA SWAYZE, LCSW, LLC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 4423 LEISURE TIME DR
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3221
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Country | US
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Telephone | 228-363-2211
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Fax | 228-255-6494
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Provider Business Mailing Address
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Address Line | 7619 FAIRWAY DR
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3436
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Country | US
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Telephone | 228-363-2211
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Fax | 228-255-6494
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Authorized Official
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Title or Position | OWNER
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Name | CORNELIA SWAYZE
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Credential | LCSW
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Telephone | 228-363-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C4648
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License Number State | MS
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