Healthcare Provider Details

I. General information

NPI: 1518351063
Provider Name (Legal Business Name): CHRISTINE INGRID MARIKA STEWART LCPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 E NC HIGHWAY 54 BLDG 2200
DURHAM NC
27713-5251
US

IV. Provider business mailing address

2515 E NC HIGHWAY 54 BLDG 2200
DURHAM NC
27713-5251
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-0959
  • Fax:
Mailing address:
  • Phone: 919-493-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA11529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: