Provider Demographics
NPI:1174715981
Name:SWALM, CYNTHIA MARIE (CADC-II A3620592)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:SWALM
Suffix:
Gender:F
Credentials:CADC-II A3620592
Other - Prefix:
Other - First Name:CINDI
Other - Middle Name:MARIE
Other - Last Name:SWALM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1021 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8136
Mailing Address - Country:US
Mailing Address - Phone:530-541-2445
Mailing Address - Fax:530-541-0517
Practice Address - Street 1:1021 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8136
Practice Address - Country:US
Practice Address - Phone:530-541-2445
Practice Address - Fax:530-541-0517
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)