Provider Demographics
NPI:1710484449
Name:FEFEE, ANTIONETTE DIANE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ANTIONETTE
Middle Name:DIANE
Last Name:FEFEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18004 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1891
Mailing Address - Country:US
Mailing Address - Phone:312-749-4360
Mailing Address - Fax:708-895-2830
Practice Address - Street 1:18004 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1891
Practice Address - Country:US
Practice Address - Phone:312-749-4360
Practice Address - Fax:708-895-2830
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490084721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical