Provider Demographics
NPI:1598454761
Name:STEWART, JAMES DAVID
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KY HIGHWAY 328 W
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40489-9561
Mailing Address - Country:US
Mailing Address - Phone:606-386-0706
Mailing Address - Fax:
Practice Address - Street 1:103 SOUTHERN SOUL WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-6534
Practice Address - Country:US
Practice Address - Phone:859-792-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255829104100000X
KY2602531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker