Katrina Renee Chisholm, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005838 Issued in GA

Practice address

1 Youth Estate Dr
Brunswick, GA 31525-7206

Phone

(910) 330-3291

NPI assigned

Sep 27, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Solstice

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pooler, GA
  • NPI 1649968322
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476489600000",
    "number": "1396096533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 YOUTH ESTATE DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257206",
            "telephone_number": "910-330-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 YOUTH ESTATE DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257206",
            "telephone_number": "910-330-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "KATRINA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2016-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert N Chapman Sr., OD
• Charleston Vamc
• Theresa Cheek, OT
• Ningxing Chen, D.O.
• Abraham Cheong, M.D.
• Stephen A Chitty IV, MD
• Allyson Christianson, LCSW
• City Drug Store
• Clarity Center LLC
• Amber Lin Clark, RN

• Clinical Social Worker in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.