Provider Demographics
NPI:1427712785
Name:STEWART, MICHELLE DAYNISE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAYNISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 ASHLEY LANDING CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7800
Mailing Address - Country:US
Mailing Address - Phone:804-933-8839
Mailing Address - Fax:
Practice Address - Street 1:11300 ASHLEY LANDING CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7800
Practice Address - Country:US
Practice Address - Phone:804-933-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional