Provider Demographics
NPI:1922182765
Name:STEWART, MARIE ANITA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANITA
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 STANTONSBURG RD.
Mailing Address - Street 2:APT. 2B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-364-1399
Mailing Address - Fax:
Practice Address - Street 1:800 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3777
Practice Address - Country:US
Practice Address - Phone:252-830-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040060981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188190OtherANTHEM
VAO802377MOtherOPTIMA
VA009701C34Medicare ID - Type UnspecifiedMEDICARE