Provider Demographics
NPI:1144328980
Name:STEWART, TINA M (MA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:COLLIERS
Mailing Address - State:WV
Mailing Address - Zip Code:26035-0348
Mailing Address - Country:US
Mailing Address - Phone:304-723-3423
Mailing Address - Fax:304-723-3426
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 412
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-3423
Practice Address - Fax:304-723-3426
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV492101YP2500X
WVCP00451812104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001718471OtherBLUE CROSS/BLUE SHIELD