Doctor Name: | MRS. CARLA LATRISE STEWART |
NPI Number: | 1326275215 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NCC, LCPC, BCPCC |
License Number: | 178.004505 |
Business Practice Address: | 19624 Governors Highway Suite 4 Flossmoor, IL - 60422 |
Business Phone Number: | 7084814257 |
Business Fax Number: | 7084814254 |
Mailing Address: | 19624 Governors Highway, Suite 4 FLOSSMOOR |
State: | IL |
Postal Code: | 60422 |
Phone Number: | 7084814257 |
Fax Number: | 7084814254 |
NPI Enumeration Date: | 06/17/2009 |
NPI Last Update Date: | 07/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178.004505 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |