Provider Demographics
NPI:1326581984
Name:STEWART, ROBERT RAY (LISW-S, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAY
Last Name:STEWART
Suffix:
Gender:M
Credentials:LISW-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 WENDY LN
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2756
Mailing Address - Country:US
Mailing Address - Phone:614-565-3959
Mailing Address - Fax:
Practice Address - Street 1:1855 E DUBLIN GRANVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3516
Practice Address - Country:US
Practice Address - Phone:614-267-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.965639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)