Provider Demographics
NPI:1194562736
Name:AUGUST COMMONS LLC
Entity type:Organization
Organization Name:AUGUST COMMONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DENEE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LISW-CP LCAS
Authorized Official - Phone:984-292-4235
Mailing Address - Street 1:109 MARIANNA PL
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7683
Mailing Address - Country:US
Mailing Address - Phone:984-292-4235
Mailing Address - Fax:888-245-5107
Practice Address - Street 1:152 WIND CHIME CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6433
Practice Address - Country:US
Practice Address - Phone:800-574-8511
Practice Address - Fax:888-245-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty