Provider Demographics
NPI:1043994726
Name:STELLWAG, LYDIA (LCSWA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:STELLWAG
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SOUTHHILL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8644
Mailing Address - Country:US
Mailing Address - Phone:919-537-9595
Mailing Address - Fax:
Practice Address - Street 1:117 BATHGATE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5553
Practice Address - Country:US
Practice Address - Phone:919-537-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0190541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical