Provider Demographics
NPI:1003168469
Name:STEWART, ELEANOR MCMICHAEL (MED)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MCMICHAEL
Last Name:STEWART
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PIEDMONT ROAD
Mailing Address - Street 2:PIEDMONT CENTER, BLDG. EIGHT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-550-4210
Mailing Address - Fax:
Practice Address - Street 1:3525 PIEDMONT RD NE
Practice Address - Street 2:PIEDMONT CENTER, BLDG. 8, SUITE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1578
Practice Address - Country:US
Practice Address - Phone:404-550-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional