Provider Demographics
NPI:1295410462
Name:AUSTIN, URSULA ANN (LPC)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:ANN
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1920 ADDINGTON CT NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7141
Mailing Address - Country:US
Mailing Address - Phone:616-446-3621
Mailing Address - Fax:
Practice Address - Street 1:1920 ADDINGTON CT NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7141
Practice Address - Country:US
Practice Address - Phone:616-446-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor