Provider Demographics
NPI:1003489105
Name:STEWART, BRENDA LEE (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, NCC
Mailing Address - Street 1:1800 PEMBROOK DR # 300-1272
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6928
Mailing Address - Country:US
Mailing Address - Phone:407-955-9774
Mailing Address - Fax:
Practice Address - Street 1:5931 BRICK CT STE 130
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9411
Practice Address - Country:US
Practice Address - Phone:407-801-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health