Provider Demographics
NPI:1891003786
Name:STEWART, CHARLES HARMON (LMHC, CAP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HARMON
Last Name:STEWART
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5332
Mailing Address - Country:US
Mailing Address - Phone:386-254-1202
Mailing Address - Fax:386-947-2467
Practice Address - Street 1:702 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5332
Practice Address - Country:US
Practice Address - Phone:386-254-1202
Practice Address - Fax:386-947-2467
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC 13311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical