Provider Demographics
NPI:1275682122
Name:AUSTIN, JAMES EDDIE (THD,BA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDDIE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:THD,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 HACKETT DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-9382
Mailing Address - Country:US
Mailing Address - Phone:707-439-6572
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR STE K
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-453-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health