Provider Demographics
NPI:1861751828
Name:AUGUSTINE, KRISTINE (MA, LMHC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GLEN COVE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2831
Mailing Address - Country:US
Mailing Address - Phone:516-200-5604
Mailing Address - Fax:516-200-5604
Practice Address - Street 1:29 GLEN COVE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2831
Practice Address - Country:US
Practice Address - Phone:516-200-5604
Practice Address - Fax:516-200-5604
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health