Provider Demographics
NPI:1427505619
Name:AUGUST, JENNIFER (MCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:MCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BLACK DUCK REACH
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4131
Mailing Address - Country:US
Mailing Address - Phone:302-381-0121
Mailing Address - Fax:
Practice Address - Street 1:17585 NASSAU COMMONS BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6286
Practice Address - Country:US
Practice Address - Phone:302-381-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional