Healthcare Provider Details

I. General information

NPI: 1932566817
Provider Name (Legal Business Name): LESTER CHAD ROBINETTE LMSW, CAC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RONNIE CT STE 2
MYRTLE BEACH SC
29579-4192
US

IV. Provider business mailing address

220 RONNIE CT STE 2
MYRTLE BEACH SC
29579-4192
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-0346
  • Fax:
Mailing address:
  • Phone: 843-945-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10285
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number152012
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10285
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10285
License Number StateSC

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: