Provider Demographics
NPI:1265808612
Name:CAROTHERS, CHESTER A JR (LCSW)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:A
Last Name:CAROTHERS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6152
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62202-6152
Mailing Address - Country:US
Mailing Address - Phone:618-875-9355
Mailing Address - Fax:
Practice Address - Street 1:10314 LINCOLN TRL STE 106
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1801
Practice Address - Country:US
Practice Address - Phone:618-875-9355
Practice Address - Fax:630-425-8900
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0173301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical