Healthcare Provider Details

I. General information

NPI: 1487597613
Provider Name (Legal Business Name): JACQUELINE STEWART
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 DEER TRCE
PINEVILLE LA
71360-5996
US

IV. Provider business mailing address

169 MADISON AVE STE 15011
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 986-206-0414
  • Fax:
Mailing address:
  • Phone: 986-206-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1487597613
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: