Provider Demographics
NPI:1831340454
Name:STEWART, VIVIAN ELAINE (LCSW, CAP)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ELAINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:MS
Other - First Name:VIVIAN
Other - Middle Name:ELAINE
Other - Last Name:CAMPBELL-MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1467 SNOWY EGRET DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-3245
Mailing Address - Country:US
Mailing Address - Phone:678-551-0077
Mailing Address - Fax:
Practice Address - Street 1:2817 RIELLY ROAD
Practice Address - Street 2:ROBINSON HEALTH CLINIC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCAP099101YA0400X
WYLCSW-6561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)