Healthcare Provider Details

I. General information

NPI: 1992476816
Provider Name (Legal Business Name): JOSEPH BRICE AUGUST ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 162
FRESNO CA
93726-6869
US

IV. Provider business mailing address

3636 N 1ST ST STE 162
FRESNO CA
93726-6869
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2166
  • Fax:
Mailing address:
  • Phone: 559-476-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: