Provider Demographics
NPI:1891279949
Name:STEWARD, ENJOULI CAMMIE (CG 60832872)
Entity Type:Individual
Prefix:MS
First Name:ENJOULI
Middle Name:CAMMIE
Last Name:STEWARD
Suffix:
Gender:F
Credentials:CG 60832872
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13014 97TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9145
Mailing Address - Country:US
Mailing Address - Phone:253-283-8866
Mailing Address - Fax:
Practice Address - Street 1:5005 PACIFIC HWY E STE 20
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2647
Practice Address - Country:US
Practice Address - Phone:253-922-6522
Practice Address - Fax:253-922-6955
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60832872405300000X
WACP60893863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional