Provider Demographics
NPI:1740773571
Name:ANTOINE, EDWIDGE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:EDWIDGE
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 NW 87TH LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7185
Mailing Address - Country:US
Mailing Address - Phone:954-716-5397
Mailing Address - Fax:
Practice Address - Street 1:586 NW 87TH LN
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7185
Practice Address - Country:US
Practice Address - Phone:954-716-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health