Provider Demographics
NPI:1194596544
Name:VOTAW, ANTOINE R (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:R
Last Name:VOTAW
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 VINTAGE PL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-8512
Mailing Address - Country:US
Mailing Address - Phone:214-356-2564
Mailing Address - Fax:
Practice Address - Street 1:3001 W 5TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-8900
Practice Address - Country:US
Practice Address - Phone:214-356-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health