Provider Demographics
NPI:1558520395
Name:AUGUSTINE, ANGELA T (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:T
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:T
Other - Last Name:LANCIANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 4962
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-4962
Mailing Address - Country:US
Mailing Address - Phone:216-262-8130
Mailing Address - Fax:
Practice Address - Street 1:637 ESSEX FOREST DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9242
Practice Address - Country:US
Practice Address - Phone:216-262-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10034Medicaid
OH10024Medicaid