Healthcare Provider Details

I. General information

NPI: 1942847843
Provider Name (Legal Business Name): AISHIA CHENERY CHESTNUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8903
US

IV. Provider business mailing address

401 BEULAH CIR
CONWAY SC
29527-3795
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5060
  • Fax:
Mailing address:
  • Phone: 843-516-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9072
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: