Provider Demographics
NPI:1598204133
Name:JAMES, ANTONETT CLARESE (LLMSW)
Entity Type:Individual
Prefix:
First Name:ANTONETT
Middle Name:CLARESE
Last Name:JAMES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 BALDWIN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1115
Mailing Address - Country:US
Mailing Address - Phone:248-706-3450
Mailing Address - Fax:248-706-3455
Practice Address - Street 1:1685 BALDWIN AVE
Practice Address - Street 2:STE A
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1115
Practice Address - Country:US
Practice Address - Phone:248-706-3450
Practice Address - Fax:248-706-3455
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010997441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical