Provider Demographics
NPI:1699095943
Name:AUGUSTIN, CAROLINE COTHRAN (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:COTHRAN
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 LEONARD PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1808
Mailing Address - Country:US
Mailing Address - Phone:804-308-2084
Mailing Address - Fax:
Practice Address - Street 1:5700 W GRACE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1832
Practice Address - Country:US
Practice Address - Phone:804-308-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional