Provider Demographics
NPI:1629168257
Name:STEWART, KENNETH (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PURDUE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5510
Mailing Address - Country:US
Mailing Address - Phone:910-693-7777
Mailing Address - Fax:910-693-1524
Practice Address - Street 1:160 PINEHURST AVE STE J
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7078
Practice Address - Country:US
Practice Address - Phone:910-693-7777
Practice Address - Fax:910-693-1524
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002108104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002657Medicaid