Individual provider · NPI-1

Tequila Chester

Counselor · Ellenwood, GA

NPI number1417418294
StatusActive
Last updated in NPPESMar 26, 2019

Details

NPI
1417418294
Entity type
Individual (NPI-1)
Name
Tequila Chester
Sex
Female
Sole proprietor
No
Enumeration date
Mar 26, 2019
Last updated
Mar 26, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101Y00000X Counselor––Yes

Practice location

4818 Silverbush Ln
Ellenwood, GA 30294-6710

Phone 774-302-9476

Mailing address

4818 Silverbush Ln
Ellenwood, GA 30294-6710

Phone 774-302-9476

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