Provider Demographics
NPI:1689989048
Name:AUGUSTINE, CATHY J (CSAC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 TWILIGHT DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1361
Mailing Address - Country:US
Mailing Address - Phone:920-338-9497
Mailing Address - Fax:
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-323-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11559-132101YA0400X
WI326-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist