Provider Demographics
NPI:1881798577
Name:STEWART, DAVID T (DIPCS, M ED,LPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:STEWART
Suffix:
Gender:M
Credentials:DIPCS, M ED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 FLOYD HWY N
Mailing Address - Street 2:
Mailing Address - City:CHECK
Mailing Address - State:VA
Mailing Address - Zip Code:24072
Mailing Address - Country:US
Mailing Address - Phone:540-651-2173
Mailing Address - Fax:
Practice Address - Street 1:5967 FLOYD HWY N
Practice Address - Street 2:
Practice Address - City:CHECK
Practice Address - State:VA
Practice Address - Zip Code:24072-3011
Practice Address - Country:US
Practice Address - Phone:540-641-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA305657OtherANTHEM
VA302511OtherANTHEM
VA11548912OtherCAQH
VA010282551Medicaid