Healthcare Provider Details

I. General information

NPI: 1437719960
Provider Name (Legal Business Name): ANTOINETTE MONIQUE CHAPMAN LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANTOINETTE MONIQUE MILLER LPC, CAADC

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MARTIN LUTHER KING JR ST
GRAND RAPIDS MI
49507-1304
US

IV. Provider business mailing address

601 MARTIN LUTHER KING JR ST
GRAND RAPIDS MI
49507-1304
US

V. Phone/Fax

Practice location:
  • Phone: 616-570-0573
  • Fax: 616-965-3460
Mailing address:
  • Phone: 616-570-0573
  • Fax: 616-965-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401222860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: