Provider Demographics
NPI:1992139638
Name:STEWART, TRAVER (LPC, LCAS-A)
Entity type:Individual
Prefix:
First Name:TRAVER
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:LPC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4650
Mailing Address - Country:US
Mailing Address - Phone:252-521-1434
Mailing Address - Fax:
Practice Address - Street 1:3020 NC HIGHWAY 58 N
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NC
Practice Address - Zip Code:28585-9574
Practice Address - Country:US
Practice Address - Phone:252-521-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22163101YA0400X
NC10122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)