Provider Demographics
NPI:1699382309
Name:STEWART, JUSTIN RAY (CADC II)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY
Last Name:STEWART
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43535 CORTE BARBASTE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3934
Mailing Address - Country:US
Mailing Address - Phone:760-616-0488
Mailing Address - Fax:
Practice Address - Street 1:43460 RIDGE PARK DR STE 245
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3736
Practice Address - Country:US
Practice Address - Phone:760-616-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI29750520101YA0400X
CAA052470721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)