Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4605 | AZ |
NPI | 1063808558 |
---|---|
Provider Name | Dr. Alicja Stewart |
First Address | Surprise, AZ 85374-7280 |
Second Address | Surprise, AZ 85374-7280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 16/07/2015 |