Provider Demographics
NPI:1639538572
Name:STEWART, ERNESTINE (LPC-A, LCAS-A, LGPC)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC-A, LCAS-A, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:4
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:4
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5574
Practice Address - Country:US
Practice Address - Phone:336-504-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-21
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15144101YP2500X
MDLGP9798101YP2500X
NCLCAS-21879101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional