Healthcare Provider Details

I. General information

NPI: 1114799285
Provider Name (Legal Business Name): ANITRA STEWART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 SATIN LILY DR
RIVERVIEW FL
33579
US

IV. Provider business mailing address

6421 N FLORIDA AVE # D-504
TAMPA FL
33604-6007
US

V. Phone/Fax

Practice location:
  • Phone: 770-826-6472
  • Fax:
Mailing address:
  • Phone: 770-826-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: