Provider Demographics
NPI:1982493383
Name:OLDS, ANTIONETTE SIMONE
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:SIMONE
Last Name:OLDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 N MACARTHUR BLVD STE 120-293
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7514
Mailing Address - Country:US
Mailing Address - Phone:757-620-3903
Mailing Address - Fax:
Practice Address - Street 1:11500 LAGO VIS E APT 1314
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-6837
Practice Address - Country:US
Practice Address - Phone:757-620-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97252101YP2500X
VA0701011859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional