Provider Demographics
NPI:1659009710
Name:AUSTIN, ANGIE MICHELLE (EDS)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MICHELLE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-5642
Mailing Address - Country:US
Mailing Address - Phone:540-629-4029
Mailing Address - Fax:
Practice Address - Street 1:605 PINE ST STE 9
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1463
Practice Address - Country:US
Practice Address - Phone:276-730-3200
Practice Address - Fax:276-730-3210
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0607427103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool