Healthcare Provider Details

I. General information

NPI: 1952944407
Provider Name (Legal Business Name): SHANNAN STEWART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W. 2ND STREET
LONOKE AR
72086
US

IV. Provider business mailing address

3601 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2954
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-3151
  • Fax:
Mailing address:
  • Phone: 501-221-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2209023
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: