Basic Information
| Provider Information | |||||||||
| NPI: | 1306118872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPPAERT- STEWART | ||||||||
| FirstName: | TRACI | ||||||||
| MiddleName: | HICKS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 S B B KING BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381032626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014361381 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3421 MIKE PADGETT HWY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309063815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064324900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2012 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | MSW005229 | GA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW007055 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.