Individual
MS. ERICA CHESTNUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MC, LISAC
Contact information
Practice address
4425 W OLIVE AVE, 194, GLENDALE, AZ 85302-3843
(480) 262-0508
(602) 629-1536
Mailing address
4425 W OLIVE AVE, 194, GLENDALE, AZ 85302-3843
(480) 262-0508
(602) 629-1536
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LISAC-10600
AZ
Other
Enumeration date
10/02/2007
Last updated
10/02/2007
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