Healthcare Provider Details

I. General information

NPI: 1346668308
Provider Name (Legal Business Name): CHASITY DE BODISCO M.A. LCMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 REYNOLDA RD STE C
WINSTON SALEM NC
27106-4606
US

IV. Provider business mailing address

2422 REYNOLDA RD STE C
WINSTON SALEM NC
27106-4606
US

V. Phone/Fax

Practice location:
  • Phone: 321-527-6755
  • Fax:
Mailing address:
  • Phone: 321-527-6755
  • Fax: 321-527-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15927
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3598
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19586
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: