=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710702170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEWART OF HEALING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8109 MECHANICSVILLE TURNPIKE SUITE 1B
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-572-6629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7737 LEEDS CASTLE LN
-----------------------------------------------------
City | NEW KENT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23124-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-572-6629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | TRAVIS STEWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-572-6629
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------