Provider Demographics
NPI:1104026525
Name:POLITE, ANTAWN MAURICE (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTAWN
Middle Name:MAURICE
Last Name:POLITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 MOSSTREE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5219
Mailing Address - Country:US
Mailing Address - Phone:843-991-5015
Mailing Address - Fax:843-884-1287
Practice Address - Street 1:1231 MOSSTREE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5219
Practice Address - Country:US
Practice Address - Phone:843-991-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional