Provider Demographics
NPI:1225540891
Name:CHESTNUT, JOYCE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ELIZABETH
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 TAPLOW TRL
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-7988
Mailing Address - Country:US
Mailing Address - Phone:910-751-9959
Mailing Address - Fax:
Practice Address - Street 1:19 TAPLOW TRL
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-7988
Practice Address - Country:US
Practice Address - Phone:910-751-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC819103K00000X
NC11404225400000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner