Provider Demographics
NPI:1003237710
Name:STEWART, HEATHER (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:SAMOLEJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TF-CBT
Mailing Address - Street 1:3111 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8127
Mailing Address - Country:US
Mailing Address - Phone:810-985-8900
Mailing Address - Fax:
Practice Address - Street 1:3111 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8127
Practice Address - Country:US
Practice Address - Phone:810-985-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010955491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003237710Medicaid