Healthcare Provider Details

I. General information

NPI: 1295072478
Provider Name (Legal Business Name): ROSALIE STEWART LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 STATE FARM RD
BOONE NC
28607-4948
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-1490
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11402
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11402
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: