Provider Demographics
NPI:1326779703
Name:STEWART, BRIAN TERRYL (MSW, CBLC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TERRYL
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSW, CBLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BAYWOOD XING
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4146
Mailing Address - Country:US
Mailing Address - Phone:478-335-2854
Mailing Address - Fax:
Practice Address - Street 1:169 BAYWOOD XING
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4146
Practice Address - Country:US
Practice Address - Phone:478-335-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker