Provider Demographics
NPI:1033890116
Name:LANSANA, AUGUSTINE (MA, DMIN, PHD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:
Last Name:LANSANA
Suffix:
Gender:M
Credentials:MA, DMIN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 N HOYNE AVE APT AB
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3023
Mailing Address - Country:US
Mailing Address - Phone:412-853-2586
Mailing Address - Fax:
Practice Address - Street 1:5447 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3203
Practice Address - Country:US
Practice Address - Phone:412-853-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABHOO4017103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst