Healthcare Provider Details

I. General information

NPI: 1114368958
Provider Name (Legal Business Name): VENUS STEWART LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N CALHOUN ST
BALTIMORE MD
21217-2804
US

IV. Provider business mailing address

2227 OLD EMMORTON RD STE 119
BEL AIR MD
21015-6190
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-9497
  • Fax: 410-569-0094
Mailing address:
  • Phone: 410-569-9497
  • Fax: 410-569-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4388
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: