Provider Demographics
NPI:1366097776
Name:STEWART-TIANYVU, SIMIKO (LPC)
Entity type:Individual
Prefix:MRS
First Name:SIMIKO
Middle Name:
Last Name:STEWART-TIANYVU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WAVERLY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7805
Mailing Address - Country:US
Mailing Address - Phone:404-312-1522
Mailing Address - Fax:
Practice Address - Street 1:61 WAVERLY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7805
Practice Address - Country:US
Practice Address - Phone:912-675-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0190101YA0400X
GA007667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)