Provider Demographics
NPI:1235910662
Name:STEWART, EMMA WINDHAM
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:WINDHAM
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 PINNACLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-7610
Mailing Address - Country:US
Mailing Address - Phone:704-703-8588
Mailing Address - Fax:
Practice Address - Street 1:7491 HAGERS HOLLOW DR STE D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9223
Practice Address - Country:US
Practice Address - Phone:704-705-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst