Provider Demographics
NPI:1750827119
Name:STEWART, MARY ANN (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S. GLENBURNIE ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-600-9465
Mailing Address - Fax:252-633-1005
Practice Address - Street 1:1425 S GLENBURNIE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2626
Practice Address - Country:US
Practice Address - Phone:252-633-9465
Practice Address - Fax:252-633-1005
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12005A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist