Healthcare Provider Details

I. General information

NPI: 1164369534
Provider Name (Legal Business Name): JESSICA CHESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEVEN HILLS BLVD STE 101172
DALLAS GA
30132-0574
US

IV. Provider business mailing address

80 SEVEN HILLS BLVD STE 101
DALLAS GA
30132-0575
US

V. Phone/Fax

Practice location:
  • Phone: 843-244-1359
  • Fax:
Mailing address:
  • Phone: 843-244-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC016762
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: