Provider Demographics
NPI:1760772438
Name:STEWART, DEBORAH HUDSON (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:HUDSON
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 MOUNT ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-2963
Mailing Address - Country:US
Mailing Address - Phone:678-378-4696
Mailing Address - Fax:678-678-5594
Practice Address - Street 1:506 TANNER ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3304
Practice Address - Country:US
Practice Address - Phone:770-834-0021
Practice Address - Fax:678-648-5594
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003430101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor