Provider Demographics
NPI:1073820577
Name:STEWART, MARTHA K (MS,LPC)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:K
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 POWERS LN
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-3161
Mailing Address - Country:US
Mailing Address - Phone:843-319-5198
Mailing Address - Fax:
Practice Address - Street 1:2007 POWERS LN
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541-3161
Practice Address - Country:US
Practice Address - Phone:843-319-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1277Medicaid