Provider Demographics
NPI:1316428212
Name:SCALISE, ANTONINA (LPC-S, RPT-S, NCC)
Entity type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:SCALISE
Suffix:
Gender:F
Credentials:LPC-S, RPT-S, NCC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:SCALISE
Other - Last Name:BOROWCZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S, RPT-S, NCC
Mailing Address - Street 1:4849 GREENVILLE AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4198
Mailing Address - Country:US
Mailing Address - Phone:214-265-8689
Mailing Address - Fax:
Practice Address - Street 1:4849 GREENVILLE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4198
Practice Address - Country:US
Practice Address - Phone:214-265-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional