Provider Demographics
NPI:1699751107
Name:AUSTIN, AUTUMN COAN I (MA, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:COAN
Last Name:AUSTIN
Suffix:I
Gender:F
Credentials:MA, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8969
Mailing Address - Country:US
Mailing Address - Phone:704-225-7550
Mailing Address - Fax:704-849-0883
Practice Address - Street 1:1135 FOUR LAKES DR
Practice Address - Street 2:SUITE A
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1721
Practice Address - Country:US
Practice Address - Phone:704-651-0668
Practice Address - Fax:704-849-0883
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1926101YA0400X
NC4817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9388174OtherPRIVATE HEALTH CARE SYST
NC1398GOtherBCBS
NC7167747OtherAETNA
NC184537OtherMEDCOST
NC6102931Medicaid
NC6102580Medicaid