Individual
KOLLEEN A ANTONACCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2015 W MAIN ST, SUITE 103, CARBONDALE, IL 62901-2073
(618) 457-4044
(618) 529-3834
Mailing address
2015 W MAIN ST, SUITE 103, CARBONDALE, IL 62901-2073
(618) 457-4044
(618) 529-3834
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180.008168
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC 2699
IL
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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