Individual provider Active NPI

R Dietrich Stewart, LMFA

  • Marriage & Family Therapist
  • Charlotte, NC
National Provider Identifier
1124398094
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
7060A Issued in NC
Practice address
2101-D Yager Creek Drive
Charlotte, NC 28273
Phone
(612) 290-8825
NPI assigned
Jan 9, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 7060A NC Primary

Addresses

Primary practice location

2101-D Yager Creek Drive
Charlotte, NC 28273

Mailing address

PO Box 790172
Charlotte, NC 28206-7901
Phone (612) 290-8825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241216003781 NC Order and Referring Only - Mental Health Counselor 6800322793

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7060ANCMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1124398094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790172",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282067901",
            "telephone_number": "612-290-8825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101-D YAGER CREEK DRIVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28273",
            "telephone_number": "612-290-8825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "R DIETRICH",
        "name_prefix": "Ms.",
        "credential": "LMFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-09",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "7060A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.