Kolleen A Antonacci, LCPC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Carbondale, IL
NPI 1730513409 · NPPES record last updated Aug 29, 2013
Key facts
- NPI
- 1730513409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CADC 2699 (IL)
- Practice address
- 2015 W Main St
Suite 103
Carbondale, IL 62901-2073 - Phone
- (618) 457-4044
- Fax
- (618) 529-3834
- NPI assigned
- Aug 29, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.008168 | IL | MD | Counselor |
| CADC 2699 | IL | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180.008168 | IL | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CADC 2699 | IL | Yes |
Addresses
Primary practice location
2015 W Main St
Suite 103
Carbondale, IL 62901-2073
Mailing address
2015 W Main St
Suite 103
Carbondale, IL 62901-2073
Phone (618) 457-4044
Other names
- Colleen A Kennedy
Other providers in Carbondale, IL
- Elias Anderson
- Erin Anderson
- Joshua R Anderson
- Tiffany Andrews
- Ifeanyichukwu Alex Anoka
- Nya Anwanane
- Archway, Inc.
- Archway, Inc.
- Cheryl Ann Arnett
- Britney Nicole Arnold
All providers in Carbondale, IL · Addiction (Substance Use Disorder) Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.