Provider Demographics
NPI:1649735754
Name:STEWART, CAROL KELLY (LGPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:KELLY
Last Name:STEWART
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SPA CREEK LNDG UNIT B2
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4232
Mailing Address - Country:US
Mailing Address - Phone:703-927-9249
Mailing Address - Fax:
Practice Address - Street 1:946 NABBS CREEK RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8434
Practice Address - Country:US
Practice Address - Phone:410-890-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5603101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor