Individual
JACKIE LEE STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMS
Contact information
Practice address
14574 US HIGHWAY 23, WAVERLY, OH 45690-9373
(740) 821-1562
Mailing address
1413 WASHINGTON BLVD S, WEST PORTSMOUTH, OH 45663-5893
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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