Provider Demographics
NPI:1508993122
Name:STEWART, ANDREA MICHELLE (MFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 LEMON GROVE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2976
Mailing Address - Country:US
Mailing Address - Phone:619-713-0258
Mailing Address - Fax:619-713-1365
Practice Address - Street 1:2741 LEMON GROVE AVE
Practice Address - Street 2:#103
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2975
Practice Address - Country:US
Practice Address - Phone:619-713-0258
Practice Address - Fax:619-713-1365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist