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General NPI Number Information
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NPI Number | 1871880609
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Entity Type | Individual
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Provider Name | CHIANTE JEMISON LADC
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Gender | Male
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 1334 S MARYLAND PKWY STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89104-3310
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Country | US
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Telephone | 702-744-7350
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Fax | 702-359-6585
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Provider Business Mailing Address
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Address Line | 1334 S MARYLAND PKWY STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89104-3310
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Country | US
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Telephone | 702-744-7350
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Fax | 702-359-6585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01865-L
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License Number State | NV
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