Provider Demographics
NPI:1104424399
Name:STEWART, SHAYLA T (LISW-CP, LCSW, MPA)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:T
Last Name:STEWART
Suffix:
Gender:F
Credentials:LISW-CP, LCSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 EDEN TER APT 202
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-2818
Mailing Address - Country:US
Mailing Address - Phone:706-877-0357
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR STE 2000
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3486
Practice Address - Country:US
Practice Address - Phone:704-975-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109691041C0700X
NCC0138641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical