Provider Demographics
NPI:1326275215
Name:STEWART, CARLA LATRISE (NCC, LCPC, BCPCC)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:LATRISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:NCC, LCPC, BCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19624 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2077
Mailing Address - Country:US
Mailing Address - Phone:708-481-4257
Mailing Address - Fax:708-481-4254
Practice Address - Street 1:19630 GOVERNORS HWY STE 8
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2079
Practice Address - Country:US
Practice Address - Phone:708-481-4257
Practice Address - Fax:708-481-4254
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2246885101YS0200X
IL180.007522101YP2500X
IL101Y00000X, 101YM0800X
IL178.004505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health