Provider Demographics
NPI:1033685615
Name:STEWART-FULTON, MATTHEW (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STEWART-FULTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1925
Mailing Address - Country:US
Mailing Address - Phone:734-945-6210
Mailing Address - Fax:734-207-5326
Practice Address - Street 1:122 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1925
Practice Address - Country:US
Practice Address - Phone:734-945-6210
Practice Address - Fax:734-207-5326
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010922691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical