Provider Demographics
NPI:1013043793
Name:STEWART, JILLIAN DENIESE (LPC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:DENIESE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:DENIESE
Other - Last Name:FENNESSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11700 KANIS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3794
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:
Practice Address - Street 1:11700 KANIS RD STE 2
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3794
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:501-843-9656
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1101001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health