Provider Demographics
NPI:1710356209
Name:JOEL, AUGUSTINA O
Entity Type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:O
Last Name:JOEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUGUSTINA
Other - Middle Name:O
Other - Last Name:JOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1642 E CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6315
Mailing Address - Country:US
Mailing Address - Phone:713-909-6953
Mailing Address - Fax:
Practice Address - Street 1:1642 E CARDINAL DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6315
Practice Address - Country:US
Practice Address - Phone:713-909-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AZBH4920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)