Individual
DYLAN STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3301 E 12TH ST, #259, OAKLAND, CA 94601-3424
(510) 269-9030
Mailing address
130 PETER COUTTS CIR, STANFORD, CA 94305-2521
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
32853
CA
103T00000X
Psychologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/17/2016
Last updated
09/27/2021
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