Provider Demographics
NPI:1962645218
Name:STEWART, WILLIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:A
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CAMINO AL NORTE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2387
Mailing Address - Country:US
Mailing Address - Phone:702-787-0166
Mailing Address - Fax:
Practice Address - Street 1:222 S RAINBOW BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5343
Practice Address - Country:US
Practice Address - Phone:702-787-0166
Practice Address - Fax:702-786-6911
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NV7153-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker