Provider Demographics
NPI:1619469657
Name:AUGUSTE, BRINA N
Entity Type:Individual
Prefix:MS
First Name:BRINA
Middle Name:N
Last Name:AUGUSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRINA
Other - Middle Name:N
Other - Last Name:AUGUSTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:643 S ROSEHALL LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4267
Mailing Address - Country:US
Mailing Address - Phone:224-343-6128
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:224-343-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherLAKE COUNTY HEALTH DEPARTMENT