Provider Demographics
NPI:1104852102
Name:STEWART, AARON HERR (MA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:HERR
Last Name:STEWART
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 W MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1588
Mailing Address - Country:US
Mailing Address - Phone:336-855-6314
Mailing Address - Fax:336-855-6325
Practice Address - Street 1:3719 W MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1588
Practice Address - Country:US
Practice Address - Phone:336-855-6314
Practice Address - Fax:336-855-6325
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107215Medicaid
NC2811637Medicare ID - Type Unspecified