Basic Information
Provider Information
NPI: 1922172972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWINDELL
FirstName: LEIGH
MiddleName: A
NamePrefix: MS.
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1316 SOMERVILLE RD SE
Address2: SUITE 1
City: DECATUR
State: AL
PostalCode: 356014305
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1307 E ELM ST
Address2:  
City: ATHENS
State: AL
PostalCode: 356115318
CountryCode: US
TelephoneNumber: 2563556105
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMASTERSCOY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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