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General NPI Number Information
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NPI Number | 1790211621
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Entity Type | Individual
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Provider Name | EVODIE ANTOINE-PREDESTIN LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 7800 W OAKLAND PARK BLVD SUITE 107
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City | SUNRISE
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State | FL
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Zip | 33351-6741
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Country | US
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Telephone | 754-281-7097
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Fax |
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Provider Business Mailing Address
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Address Line | 1856 N NOB HILL RD SUITE 237
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City | PLANTATION
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State | FL
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Zip | 33322-6548
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Country | US
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Telephone | 754-281-7097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6312
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License Number State | FL
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