Provider Demographics
NPI:1164070835
Name:STEWART, TONIKA NICOLE (ALC, ED S)
Entity Type:Individual
Prefix:
First Name:TONIKA
Middle Name:NICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:ALC, ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5696 PICKETTS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126
Mailing Address - Country:US
Mailing Address - Phone:205-470-3944
Mailing Address - Fax:
Practice Address - Street 1:5696 PICKETTS CIRCLE
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126
Practice Address - Country:US
Practice Address - Phone:205-470-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1541A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor