Active NPI
Chester Wilson Jr., EDD, CAP, CMHP
- Mental Health Counselor
- Daytona Beach, FL
National Provider Identifier
1023678539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 50334
- Practice address
- 240 N Frederick Ave
Daytona Beach, FL 32114-3400 - Phone
- (386) 675-0098
- NPI assigned
- Jun 17, 2019
- Last updated
- Jun 17, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 4318 | FL | |
| Mental Health Counselor | 101YM0800X | 50334 | FL | Primary |
Addresses
Primary practice location
240 N Frederick Ave
Daytona Beach, FL 32114-3400
Mailing address
240 N Frederick Ave
Daytona Beach, FL 32114-3400
Phone (386) 675-0098
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50334 | Other | FL | CERTIFIED MENTAL HEALTH PROFESSIONAL |
| 4318 | Other | FL | CERTIFIED ADDICTION PROFESSIONAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50334 | FL | MD | Mental Health Counselor |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Daytona Beach, FL
- NPI 1043776057
-
- General Practice Physician
- Daytona Beach, FL
- NPI 1528699352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560729600000",
"number": "1023678539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 N FREDERICK AVE",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321143400",
"telephone_number": "386-675-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 N FREDERICK AVE",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321143400",
"telephone_number": "386-675-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHESTER",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "EDD, CAP, CMHP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-17",
"last_updated": "2019-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "FL",
"license": "4318",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "50334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED MENTAL HEALTH PROFESSIONAL",
"identifier": "50334",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED ADDICTION PROFESSIONAL",
"identifier": "4318",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.