Provider Demographics
NPI:1841535861
Name:ANTWINE, CURLETTE LATRICE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:CURLETTE
Middle Name:LATRICE
Last Name:ANTWINE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PEABODY RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6639
Mailing Address - Country:US
Mailing Address - Phone:707-451-0182
Mailing Address - Fax:707-454-3462
Practice Address - Street 1:2100 PEABODY RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6639
Practice Address - Country:US
Practice Address - Phone:707-451-0182
Practice Address - Fax:707-454-3462
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 103TC1900X
CA720391041C0700X, 104100000X
AZLMSW-13531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker