Provider Demographics
NPI:1700961323
Name:SCALISE, ERIC T (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:SCALISE
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 MCLAWS CIRCLE
Mailing Address - Street 2:# 2
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-564-3100
Mailing Address - Fax:757-564-3500
Practice Address - Street 1:372 MCLAWS CIRCLE
Practice Address - Street 2:# 2
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-564-3100
Practice Address - Fax:757-564-3500
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA323719OtherBLUE CROSS / BLUE SHIELD