Healthcare Provider Details

I. General information

NPI: 1104814334
Provider Name (Legal Business Name): JOSEPH JOHN SCALISE ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SUNSET DR BUILDING 200, SUITE 201
ATHENS GA
30606-2293
US

IV. Provider business mailing address

700 SUNSET DR BUILDING 200, SUITE 201
ATHENS GA
30606-2293
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-2799
  • Fax: 706-548-0334
Mailing address:
  • Phone: 706-613-2799
  • Fax: 706-548-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number812
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number236
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: