Healthcare Provider Details

I. General information

NPI: 1023442969
Provider Name (Legal Business Name): DELBERT A. CHISNELL B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CITICO ST
KNOXVILLE TN
37921-5811
US

IV. Provider business mailing address

412 CITICO ST
KNOXVILLE TN
37921-5811
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-0661
  • Fax: 865-522-3670
Mailing address:
  • Phone: 865-522-0661
  • Fax: 865-522-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: