Provider Demographics
NPI:1477275881
Name:LONDON, AUSTON MALIK (CADC-T)
Entity Type:Individual
Prefix:
First Name:AUSTON
Middle Name:MALIK
Last Name:LONDON
Suffix:
Gender:M
Credentials:CADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HERITAGE WALK
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3875
Mailing Address - Country:US
Mailing Address - Phone:678-494-5700
Mailing Address - Fax:678-494-5703
Practice Address - Street 1:270 HERITAGE WALK
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3875
Practice Address - Country:US
Practice Address - Phone:678-494-5700
Practice Address - Fax:678-494-5703
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAT0437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)