Provider Demographics
NPI:1194370825
Name:JAMES, ANTONIO MONROE
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MONROE
Last Name:JAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 MAHAFFEY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-4463
Mailing Address - Country:US
Mailing Address - Phone:941-286-4949
Mailing Address - Fax:
Practice Address - Street 1:1010 E ROSE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2016
Practice Address - Country:US
Practice Address - Phone:863-413-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor