Provider Demographics
NPI:1144418831
Name:MELISSA STEWART
Entity type:Organization
Organization Name:MELISSA STEWART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR- PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BRINSON
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, ACS, LCAS
Authorized Official - Phone:919-618-7217
Mailing Address - Street 1:1017 MEDLIN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4366
Mailing Address - Country:US
Mailing Address - Phone:919-618-7217
Mailing Address - Fax:
Practice Address - Street 1:405 MORSON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1559
Practice Address - Country:US
Practice Address - Phone:919-618-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1332251S00000X
NC3115251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102775Medicaid
NC6006278Medicaid