Healthcare Provider Details

I. General information

NPI: 1215950779
Provider Name (Legal Business Name): NANCY E. CHASTAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BONNIE LANE
SYLVA NC
28779
US

IV. Provider business mailing address

PO BOX 127
SYLVA NC
28779-0127
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004731
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier13931
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS NC
# 2
Identifier6106043
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: