Healthcare Provider Details

I. General information

NPI: 1831482413
Provider Name (Legal Business Name): MS. MAKINI I AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 EAST AVE NE UNIT A
ATLANTA GA
30312-1447
US

IV. Provider business mailing address

669 EAST AVE NE UNIT A
ATLANTA GA
30312-1447
US

V. Phone/Fax

Practice location:
  • Phone: 404-964-1099
  • Fax:
Mailing address:
  • Phone: 404-964-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: