Provider Demographics
NPI:1265183529
Name:ANTOINE, MIAUSETTE VALERIE (MSS,CAP)
Entity type:Individual
Prefix:
First Name:MIAUSETTE
Middle Name:VALERIE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:MSS,CAP
Other - Prefix:
Other - First Name:MIAUSETTE
Other - Middle Name:V
Other - Last Name:PADCUALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSS,CAP
Mailing Address - Street 1:3928 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4911
Mailing Address - Country:US
Mailing Address - Phone:386-822-9941
Mailing Address - Fax:386-788-4519
Practice Address - Street 1:3928 S NOVA RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4911
Practice Address - Country:US
Practice Address - Phone:386-822-9941
Practice Address - Fax:386-788-4519
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)