Provider Demographics
NPI:1477394518
Name:STEWART, MADDISON
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 ROCKBRIDGE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-5602
Mailing Address - Country:US
Mailing Address - Phone:717-300-0125
Mailing Address - Fax:
Practice Address - Street 1:4835 WATERLICK RD STE A
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-1696
Practice Address - Country:US
Practice Address - Phone:434-435-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health