Provider Demographics
NPI:1194377697
Name:CALVILLO DOVALINA, REBECCA ARLENE I (MA, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ARLENE
Last Name:CALVILLO DOVALINA
Suffix:I
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 PORT ISABEL DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8696
Mailing Address - Country:US
Mailing Address - Phone:956-236-4604
Mailing Address - Fax:
Practice Address - Street 1:1923 PORT ISABEL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8696
Practice Address - Country:US
Practice Address - Phone:956-236-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional