Provider Demographics
NPI:1962415281
Name:STEWART, LAURA MELISSA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MELISSA
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0800
Mailing Address - Country:US
Mailing Address - Phone:434-823-1822
Mailing Address - Fax:
Practice Address - Street 1:1186 CROZET AVENUE
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932
Practice Address - Country:US
Practice Address - Phone:434-823-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA081549OtherSOUTHERN HEALTH/SMHM
VA8919470Medicaid
VA381687OtherANTHEM/BCBS