Individual
MS. ANTOINETTE MARIE HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5080 N ELSTON AVE, CHICAGO, IL 60630-2459
(773) 769-4313
Mailing address
5080 N ELSTON AVE, CHICAGO, IL 60630-2459
(773) 769-4313
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
IL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
IL
Enumeration date
07/12/2021
Last updated
07/12/2021
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