Provider Demographics
NPI:1851456677
Name:STEWART, SUSAN ANN (MA,LLP,LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA,LLP,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-922-2300
Mailing Address - Fax:248-922-2304
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 312
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-922-2300
Practice Address - Fax:248-922-2304
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health