MEDICARE: LATRESHA CHISOLM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC12141PC	SC

General Provider Information

NPI Number	:	1043141252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRESHA CHISOLM

Provider Business Mailing Address
First Line	:	240 EDDINGS POINT RD
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3912
Country	:	US
Telephone Number	:	843-592-8806
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 EDDINGS POINT RD
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3912
Country	:	US
Telephone Number	:	843-592-8806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ LATRESHA CHISOLM ” Practice Location

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