Provider Demographics
NPI:1467540377
Name:STEWART, MIKE R (MDIV, MA,, LPC)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:R
Last Name:STEWART
Suffix:
Gender:M
Credentials:MDIV, MA,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4911
Mailing Address - Country:US
Mailing Address - Phone:828-322-4941
Mailing Address - Fax:828-322-4931
Practice Address - Street 1:263 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4911
Practice Address - Country:US
Practice Address - Phone:828-322-4941
Practice Address - Fax:828-322-4931
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCN C 2703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10087OtherBLUE CROSS BLUE SHIELD NC
NC10087OtherMAGELLAN
NC2116300OtherMAMSI
NC6102372Medicaid
NC69876OtherMEDCOST