Healthcare Provider Details

I. General information

NPI: 1013527514
Provider Name (Legal Business Name): HANNAH MARY MOXLEY STEWART M.A. LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 BLACK TUPELO CT
MONCKS CORNER SC
29461-2907
US

IV. Provider business mailing address

213 BLACK TUPELO CT
MONCKS CORNER SC
29461-2907
US

V. Phone/Fax

Practice location:
  • Phone: 559-801-4005
  • Fax:
Mailing address:
  • Phone: 559-801-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10202
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: