You can make a voice call directly from a Node.js app using Twilio Programmable Voice, which allows you to integrate voice communications into your software application. To set up the environment, create a new Node.js project and install the Twilio Node Helper Library, then configure Twilio credentials as environment variables. Next, buy a Twilio phone number and create a TwiML bin that defines how the call should be handled when it's made from the purchased number. Finally, use the Twilio client to make a phone call from your Node.js app by creating a new call with the Twilio phone number, your personal phone number, and the URL of the TwiML bin.