Provider Demographics
NPI:1619050291
Name:CHASTAIN, ANTONINA JEAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANTONINA
Middle Name:JEAN
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:LESTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63654-0058
Mailing Address - Country:US
Mailing Address - Phone:573-637-2499
Mailing Address - Fax:
Practice Address - Street 1:5460 MYSTIC OAKS DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3433
Practice Address - Country:US
Practice Address - Phone:573-637-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical