Provider Demographics
NPI:1609056464
Name:STEWART, RAYMOND A (CDP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:A
Last Name:STEWART
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SW 350TH CT
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8104
Mailing Address - Country:US
Mailing Address - Phone:253-835-9083
Mailing Address - Fax:253-942-9083
Practice Address - Street 1:707 SW 350TH CT
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-8104
Practice Address - Country:US
Practice Address - Phone:253-835-9083
Practice Address - Fax:253-942-9083
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001652101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)