Antwine, Damien

Antwine, Damien is an individual health care provider with primary practice located at 402 Richards St , Joliet IL 60433-2218. He recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as his primary health care specialty. Antwine, Damien can be contacted via phone (815) 727-5271.

Contact Information

Primary practice address
402 Richards St Joliet IL 60433-2218
Phone: (815) 727-5271
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X 1185755 Illinois

Profile Details

NPI number 1225792427
LBN Legal business name Antwine, Damien
Credentials NCSP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2021
Last updated Oct 25th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225792427 NPPES
Illinois MEDICAID 6099042
Illinois MEDICAID 1185755
Illinois MEDICAID 63445

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