Healthcare Provider Details

I. General information

NPI: 1477275881
Provider Name (Legal Business Name): AUSTON MARK LONDON CADC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 HOMER CLAYTON DRIVE
GUNTERSVILLE AL
35976
US

IV. Provider business mailing address

2409 HOMER CLAYTON DRIVE
GUNTERSVILLE AL
35976
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-3203
  • Fax: 256-582-3216
Mailing address:
  • Phone: 256-582-3203
  • Fax: 256-582-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT0437
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: