=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902269053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI CHESTER LCMHC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2016
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 DEWITT ST # 10
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-939-1127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 722 CEDAR POINT BLVD # 186
-----------------------------------------------------
City | CEDAR POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-8012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-939-1127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 000618429
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | A21197
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------