Provider Demographics
NPI:1891141248
Name:AUSTIN, LEONORA CAMILLE (DCC)
Entity Type:Individual
Prefix:DR
First Name:LEONORA
Middle Name:CAMILLE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 EZRA CHURCH DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-1807
Mailing Address - Country:US
Mailing Address - Phone:404-545-1190
Mailing Address - Fax:
Practice Address - Street 1:1690 EZRA CHURCH DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-1807
Practice Address - Country:US
Practice Address - Phone:404-545-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X, 171M00000X, 174H00000X
GA10654101YP1600X, 101YP2500X, 106H00000X
NY133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator