Provider Demographics
NPI:1578974788
Name:STEWART, KINLEE
Entity Type:Individual
Prefix:
First Name:KINLEE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W. BROAD ST
Mailing Address - Street 2:APT 233
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:757-472-5143
Mailing Address - Fax:
Practice Address - Street 1:409 E. MAIN ST
Practice Address - Street 2:#204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219
Practice Address - Country:US
Practice Address - Phone:757-472-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health