Provider Demographics
NPI:1164135877
Name:STEWART, SALLY (LGSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-4017
Mailing Address - Country:US
Mailing Address - Phone:304-531-7100
Mailing Address - Fax:
Practice Address - Street 1:713 BIGLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3356
Practice Address - Country:US
Practice Address - Phone:304-895-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW122216452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker