Provider Demographics
NPI:1902996622
Name:SWYRTEK, DIANNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:SWYRTEK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8914
Mailing Address - Country:US
Mailing Address - Phone:810-938-4845
Mailing Address - Fax:
Practice Address - Street 1:2360 S LINDEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5420
Practice Address - Country:US
Practice Address - Phone:810-732-0560
Practice Address - Fax:810-732-6351
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional