Provider Demographics
NPI:1184649253
Name:STEWART, MICHELE YVETTE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:YVETTE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14733 CHADRON AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3558
Mailing Address - Country:US
Mailing Address - Phone:313-624-7464
Mailing Address - Fax:
Practice Address - Street 1:14670 ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1892
Practice Address - Country:US
Practice Address - Phone:248-559-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062272101YM0800X
68010622721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801062272OtherSTATE LIC