MEDICARE: SIARA STEWART LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1265055347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIARA STEWART LPC

Provider Business Mailing Address
First Line	:	1811 HUGUENOT RD STE 408
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-5609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 WYNDHAM LAKE DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7072
Country	:	US
Telephone Number	:	804-464-7005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/22/2020

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