Provider Demographics
NPI:1649293804
Name:ANTOINE, DENISE WATKINS
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:WATKINS
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W COTTON ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-4442
Mailing Address - Country:US
Mailing Address - Phone:337-363-6869
Mailing Address - Fax:337-363-7420
Practice Address - Street 1:414 W COTTON ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4442
Practice Address - Country:US
Practice Address - Phone:337-363-6869
Practice Address - Fax:337-363-7420
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR1329101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)