Provider Demographics
NPI:1619274008
Name:STEWART, QIANA (PCC-S)
Entity Type:Individual
Prefix:
First Name:QIANA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CALGARY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2010
Mailing Address - Country:US
Mailing Address - Phone:614-286-1873
Mailing Address - Fax:
Practice Address - Street 1:670 MERIDIAN WAY
Practice Address - Street 2:#285
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-429-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700302101YP2500X
OHE.0700302101YP2500X
OHE.0700302-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154758Medicaid