Basic Information
| Provider Information | |||||||||
| NPI: | 1487170866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTOINE | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | ANJENETTA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 HUDSON LN STE 202 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712016032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185705400 | ||||||||
| FaxNumber: | 3185705403 | ||||||||
| Practice Location | |||||||||
| Address1: | 2807 EVANGELINE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712013749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186547667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.