Provider Demographics
NPI:1063779064
Name:AUSTIN, CHRISTY ANN (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CHARLESTON ROW BLVD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6573
Mailing Address - Country:US
Mailing Address - Phone:419-376-6291
Mailing Address - Fax:
Practice Address - Street 1:156 CHARLESTON ROW BLVD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6573
Practice Address - Country:US
Practice Address - Phone:419-376-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66797101YP2500X
OHC0800111101YP2500X
SC5534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional