Individual provider Active NPI

Mary E Stewart

  • Mental Health Counselor
  • Reston, VA
National Provider Identifier
1063084077
Registry record updated Jul 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0704013164 Issued in VA
Practice address
11250 Roger Bacon Dr BLDG 10
Reston, VA 20190-5219
Phone
(703) 483-9442
NPI assigned
Jul 11, 2021
Last updated
Jul 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 0704013164 VA Primary

Addresses

Primary practice location

11250 Roger Bacon Dr BLDG 10
Reston, VA 20190-5219

Mailing address

11250 Roger Bacon Dr BLDG 10
Reston, VA 20190-5219

Other practice location 1

11250 Roger Bacon Dr Bldg 10
Reston, VA 20190-5219
Phone (703) 483-9442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0704013164VAMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625961600000",
    "number": "1063084077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11250 ROGER BACON DR BLDG 10",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11250 ROGER BACON DR BLDG 10",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905219",
            "telephone_number": "703-483-9442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11250 Roger Bacon Dr Bldg 10",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201905219",
            "country_code": "US",
            "telephone_number": "703-483-9442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWART",
        "first_name": "MARY",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-11",
        "last_updated": "2021-07-11",
        "certification_date": "2021-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704013164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.