Provider Demographics
NPI:1962451500
Name:STEWART, CONNELLY CRAWFORD (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CONNELLY
Middle Name:CRAWFORD
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6544
Mailing Address - Country:US
Mailing Address - Phone:240-626-8301
Mailing Address - Fax:
Practice Address - Street 1:335 S MARKET ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6544
Practice Address - Country:US
Practice Address - Phone:240-626-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional