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General NPI Number Information
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NPI Number | 1871661561
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Entity Type | Individual
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Provider Name | KELLI STEWART MSW, LCSW, MDIV
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 351 WAGONER DR STE 319
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4671
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Country | US
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Telephone | 919-721-8602
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 S HORNER BLVD 1371
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City | SANFORD
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State | NC
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Zip | 27331-5709
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Country | US
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Telephone | 919-721-8602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C007077
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C007077
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License Number State | NC
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