Healthcare Provider Details

I. General information

NPI: 1326029596
Provider Name (Legal Business Name): PATRICIA CHESNUT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 TAKOMA AVE
GREENEVILLE TN
37743-4629
US

IV. Provider business mailing address

PO BOX 37087
BALTIMORE MD
21297-3087
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-0491
  • Fax: 423-636-2425
Mailing address:
  • Phone: 828-687-6282
  • Fax: 828-687-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000004202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: