Provider Demographics
NPI:1376566083
Name:STEWART, CHARLES LESLIE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LESLIE
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ASHFORD PL
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-5605
Mailing Address - Country:US
Mailing Address - Phone:636-933-6440
Mailing Address - Fax:
Practice Address - Street 1:37 ASHFORD PL
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-5605
Practice Address - Country:US
Practice Address - Phone:636-933-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical