Provider Demographics
NPI:1659124584
Name:DIBARTOLO, ELAINE MARIA (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIA
Last Name:DIBARTOLO
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 N STATE HIGHWAY 161 APT 4118
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-1496
Mailing Address - Country:US
Mailing Address - Phone:210-386-3939
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 604
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8051
Practice Address - Country:US
Practice Address - Phone:469-946-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional