Provider Demographics
NPI:1407888274
Name:AUGUSTSON, EDITH M (NCC, LCPC, LCAD-C)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:M
Last Name:AUGUSTSON
Suffix:
Gender:F
Credentials:NCC, LCPC, LCAD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5004
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-0004
Mailing Address - Country:US
Mailing Address - Phone:410-705-1331
Mailing Address - Fax:410-938-2237
Practice Address - Street 1:PO BOX 5004
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-0004
Practice Address - Country:US
Practice Address - Phone:410-705-1331
Practice Address - Fax:410-938-2237
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA451101YA0400X
MDLC2284101YM0800X
MD93405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health