Provider Demographics
NPI:1750390951
Name:AUGUSTINE, CHRIS A (MA LPC SCL)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:A
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MA LPC SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 DEVON ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2646
Mailing Address - Country:US
Mailing Address - Phone:269-324-0156
Mailing Address - Fax:
Practice Address - Street 1:2019 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1630
Practice Address - Country:US
Practice Address - Phone:269-345-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005323101Y00000X
MI011191101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool