Provider Demographics
NPI:1043571698
Name:STEWARD, MICHAEL ALLEN (BA, CAS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:STEWARD
Suffix:
Gender:M
Credentials:BA, CAS
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Mailing Address - Street 1:3340 KEMPER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4906
Mailing Address - Country:US
Mailing Address - Phone:619-523-8121
Mailing Address - Fax:618-523-8742
Practice Address - Street 1:3340 KEMPER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4906
Practice Address - Country:US
Practice Address - Phone:619-523-8121
Practice Address - Fax:618-523-8742
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA7157014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA370069INMedicaid