Provider Demographics
NPI:1821412487
Name:STEWARD, VATOGNA
Entity Type:Individual
Prefix:
First Name:VATOGNA
Middle Name:
Last Name:STEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 PARLIAMENT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2257
Mailing Address - Country:US
Mailing Address - Phone:704-564-0568
Mailing Address - Fax:980-225-0195
Practice Address - Street 1:7950 NATIONS FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
Practice Address - Country:US
Practice Address - Phone:704-564-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10315101YA0400X, 101YP2500X, 175T00000X, 101YM0800X
SC6774101YM0800X, 101YP2500X
NC1706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No175T00000XOther Service ProvidersPeer Specialist