Provider Demographics
NPI:1104305606
Name:AUSTIN, GENEVA SHAREE
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:SHAREE
Last Name:AUSTIN
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 1:1002 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1416
Mailing Address - Country:US
Mailing Address - Phone:866-452-5273
Mailing Address - Fax:310-399-6545
Practice Address - Street 1:1002 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1416
Practice Address - Country:US
Practice Address - Phone:866-452-5273
Practice Address - Fax:310-399-6545
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)