Provider Demographics
NPI:1376360024
Name:AUGUSTIN, LOUISENA EMMANUELLA
Entity type:Individual
Prefix:
First Name:LOUISENA
Middle Name:EMMANUELLA
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W BROWARD BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1065
Mailing Address - Country:US
Mailing Address - Phone:904-434-0905
Mailing Address - Fax:
Practice Address - Street 1:3900 W BROWARD BLVD APT 308
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1065
Practice Address - Country:US
Practice Address - Phone:904-434-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty