Provider Demographics
NPI:1730868175
Name:STEWART, BRYAN MION (LCAS-A, LCMHC-A)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:MION
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCAS-A, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2701
Mailing Address - Country:US
Mailing Address - Phone:336-725-8389
Mailing Address - Fax:
Practice Address - Street 1:723 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1107
Practice Address - Country:US
Practice Address - Phone:828-350-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28789101YA0400X
NCA18527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)