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General NPI Number Information
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NPI Number | 1245711456
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Entity Type | Organization
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Legal Business Name | ANGELA C. STEWART, LPC, P.C.
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 160 CLAIREMONT AVE STE 200
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City | DECATUR
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State | GA
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Zip | 30030-2546
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Country | US
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Telephone | 404-791-2004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 954
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City | CONLEY
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State | GA
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Zip | 30288-0954
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Country | US
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Telephone | 770-595-2202
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ANGELA STEWART
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Credential | LPC, PHD
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Telephone | 404-791-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC004598
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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