Healthcare Provider Details

I. General information

NPI: 1922024918
Provider Name (Legal Business Name): CHRISTINE LOUISE STEWART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHRISTINE LOUISE JENKINS

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MANOR DR
DANVILLE IN
46122-9400
US

IV. Provider business mailing address

PO BOX 390
DANVILLE IN
46122-0390
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-0044
  • Fax: 317-745-5219
Mailing address:
  • Phone: 317-718-0044
  • Fax: 317-745-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34100083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: