Provider Demographics
NPI:1962558254
Name:AUSTIN, YOLANDA MICHELE (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:MICHELE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 THEODORE LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3219
Mailing Address - Country:US
Mailing Address - Phone:704-698-2867
Mailing Address - Fax:704-698-2869
Practice Address - Street 1:212 W 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4055
Practice Address - Country:US
Practice Address - Phone:704-854-8399
Practice Address - Fax:704-854-8410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103384Medicaid