Provider Demographics
NPI:1417281817
Name:STEWART, MARK DAVID (MALCAS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:STEWART
Suffix:
Gender:M
Credentials:MALCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAWTERDALE CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:828-582-9741
Mailing Address - Fax:
Practice Address - Street 1:4 LAWTERDALE CIR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:828-582-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional