Provider Demographics
NPI:1922688647
Name:HOLSTON, CHESLEY YASMIA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:CHESLEY
Middle Name:YASMIA
Last Name:HOLSTON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BLUE SKY DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7299
Mailing Address - Country:US
Mailing Address - Phone:704-307-3699
Mailing Address - Fax:
Practice Address - Street 1:135 BLUE SKY DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7299
Practice Address - Country:US
Practice Address - Phone:704-307-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2023-04-26
Deactivation Date:2023-03-28
Deactivation Code:
Reactivation Date:2023-04-17
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician