Individual
DESTINEE ANTILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROGRAM ADMINISTRATO
Contact information
Practice address
3625 14TH ST, RIVERSIDE, CA 92501-3815
(951) 955-1540
Mailing address
3625 14TH ST, RIVERSIDE, CA 92501-3815
(951) 955-1540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/28/2009
Last updated
03/31/2025
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