Provider Demographics
NPI:1770800393
Name:STEWART, VIRGINIA SIMMONS (MSW, PLCSW)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:SIMMONS
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:701 WELLS STREET
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-1819
Mailing Address - Country:US
Mailing Address - Phone:843-479-8073
Mailing Address - Fax:
Practice Address - Street 1:303B S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3833
Practice Address - Country:US
Practice Address - Phone:910-610-4494
Practice Address - Fax:910-610-4161
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0045801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical