Provider Demographics
NPI:1417014200
Name:STEWART, CAREN (MA, LPCS)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LEGION ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4825
Mailing Address - Country:US
Mailing Address - Phone:704-460-2317
Mailing Address - Fax:843-962-5277
Practice Address - Street 1:800 LEGION ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4825
Practice Address - Country:US
Practice Address - Phone:704-460-2317
Practice Address - Fax:843-962-5277
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6567101YP2500X
SC583101YP2500X
SC5068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102836Medicaid