Individual
ANTINA MICHELLE ANTILIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-R
Contact information
Practice address
3397 DELTA WATERS RD, MEDFORD, OR 97504-5852
(541) 772-4648
(541) 858-7593
Mailing address
12890 QUINTA WAY, DESERT HOT SPRINGS, CA 92240-4852
(760) 329-2959
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/09/2018
Last updated
02/28/2022
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