Provider Demographics
NPI:1396418836
Name:AUGUSTINE, ALEXANDRIA DEMETRIUS
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:DEMETRIUS
Last Name:AUGUSTINE
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 1:5600 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1811
Mailing Address - Country:US
Mailing Address - Phone:210-705-2431
Mailing Address - Fax:
Practice Address - Street 1:5730 NORTHWEST PKWY STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3378
Practice Address - Country:US
Practice Address - Phone:188-875-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician