Healthcare Provider Details

I. General information

NPI: 1447848809
Provider Name (Legal Business Name): ANTONETTE N HUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2021
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S GAINES ST APT 1608
PORTLAND OR
97239-4769
US

IV. Provider business mailing address

650 S GAINES ST APT 1608
PORTLAND OR
97239-4769
US

V. Phone/Fax

Practice location:
  • Phone: 706-289-5800
  • Fax:
Mailing address:
  • Phone: 706-289-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0476
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.0992737
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21314
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006580
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL15493
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: