Provider Demographics
NPI:1891266631
Name:CONNELLY STEWART COUNSELING, LLC
Entity type:Organization
Organization Name:CONNELLY STEWART COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:240-626-8301
Mailing Address - Street 1:100 N COURT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5416
Mailing Address - Country:US
Mailing Address - Phone:240-626-8301
Mailing Address - Fax:
Practice Address - Street 1:100 N COURT ST STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5416
Practice Address - Country:US
Practice Address - Phone:240-626-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty