Provider Demographics
NPI:1508885518
Name:AUSTIN, CHARLES EUGENE (LCSW, LCDC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EUGENE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 1965
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:RHINELAND PLAZ
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:637-186-1710
Mailing Address - Fax:631-186-6123
Practice Address - Street 1:CMR 402
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:RHINELAND PLAZ
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:637-186-1710
Practice Address - Fax:637-186-6123
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1838101YA0400X
TX185631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical