Healthcare Provider Details

I. General information

NPI: 1245711456
Provider Name (Legal Business Name): ANGELA C. STEWART, LPC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CLAIREMONT AVE STE 200
DECATUR GA
30030-2546
US

IV. Provider business mailing address

PO BOX 954
CONLEY GA
30288-0954
US

V. Phone/Fax

Practice location:
  • Phone: 404-791-2004
  • Fax:
Mailing address:
  • Phone: 770-595-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC004598
License Number StateGA

VIII. Authorized Official

Name: ANGELA STEWART
Title or Position: OWNER/DIRECTOR
Credential: LPC, PHD
Phone: 404-791-2004