Provider Demographics
NPI:1700939790
Name:AUGUSTIN, GARY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7022 NIUMALU LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1636
Mailing Address - Country:US
Mailing Address - Phone:808-381-2675
Mailing Address - Fax:
Practice Address - Street 1:46-020 ALALOA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3828
Practice Address - Country:US
Practice Address - Phone:808-381-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist