Provider Demographics
NPI:1174690663
Name:PENNYCOOKE, ANTOINLETE CHEREF (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINLETE
Middle Name:CHEREF
Last Name:PENNYCOOKE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MISS
Other - First Name:ANTOINLETE
Other - Middle Name:CHEREF
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:PO BOX 536064
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32853-6064
Mailing Address - Country:US
Mailing Address - Phone:407-403-1221
Mailing Address - Fax:
Practice Address - Street 1:8865 COMMODITY CIR
Practice Address - Street 2:UNIT 14, SUITE 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9077
Practice Address - Country:US
Practice Address - Phone:407-403-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health