Provider Demographics
NPI:1104020007
Name:GARBA, AUGUSTINA O (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:O
Last Name:GARBA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4921
Mailing Address - Country:US
Mailing Address - Phone:414-630-0102
Mailing Address - Fax:414-755-7541
Practice Address - Street 1:8515 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4921
Practice Address - Country:US
Practice Address - Phone:414-630-0102
Practice Address - Fax:414-755-7541
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3758-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3758-125OtherPROFESSIONAL COUNSELOR
WI43703200Medicaid