Provider Demographics
NPI:1558923086
Name:STEWART, LISA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 S TRYON ST STE F-369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7652
Mailing Address - Country:US
Mailing Address - Phone:980-292-0708
Mailing Address - Fax:
Practice Address - Street 1:11940 CAROLINA PLACE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7471
Practice Address - Country:US
Practice Address - Phone:877-876-3783
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO123391041C0700X
NCC0146551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical