Provider Demographics
NPI:1346594074
Name:AUGUSTIN, DAVID NICSON (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NICSON
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SW 168TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4569
Mailing Address - Country:US
Mailing Address - Phone:786-430-1051
Mailing Address - Fax:786-430-1062
Practice Address - Street 1:8900 SW 168TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4569
Practice Address - Country:US
Practice Address - Phone:786-430-1051
Practice Address - Fax:786-430-1062
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health