Provider Demographics
NPI:1710964267
Name:AUSTIN, LUCY ANN (MDIV)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4604
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-4604
Mailing Address - Country:US
Mailing Address - Phone:336-852-3733
Mailing Address - Fax:336-852-3199
Practice Address - Street 1:1621 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3703
Practice Address - Country:US
Practice Address - Phone:336-852-3733
Practice Address - Fax:336-852-3199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1950101YP1600X
NC167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131UHOtherBLUE CROSS BLUE SHIELD
NC164633OtherVALUE OPTIONS ID