Individual
DR. CHESTER WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD, CAP, CMHP
Contact information
Practice address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 675-0098
Mailing address
240 N FREDERICK AVE, DAYTONA BEACH, FL 32114-3400
(386) 675-0098
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
4318
FL
101YM0800X
Mental Health Counselor
Primary
50334
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4318
CERTIFIED ADDICTION PROFESSIONAL
FL
01
—
50334
CERTIFIED MENTAL HEALTH PROFESSIONAL
FL
Enumeration date
06/17/2019
Last updated
06/17/2019
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