Provider Demographics
NPI:1003515305
Name:DUCKETT, ANTOINETTE DENISE (RADT)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:DENISE
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37049 33RD ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6649
Mailing Address - Country:US
Mailing Address - Phone:818-836-8871
Mailing Address - Fax:
Practice Address - Street 1:37049 33RD ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6649
Practice Address - Country:US
Practice Address - Phone:818-836-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAR1492341222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program