Provider Demographics
NPI:1033512025
Name:STEWART, CHARLOTTE V (LPC,NCC)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:V
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5559
Mailing Address - Country:US
Mailing Address - Phone:478-747-6884
Mailing Address - Fax:
Practice Address - Street 1:116 WOODMONT DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5559
Practice Address - Country:US
Practice Address - Phone:478-747-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC007899OtherLPC