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General NPI Number Information
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NPI Number | 1619024627
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Entity Type | Individual
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Provider Name | CARL G AUSTIN M.A.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2425 S VOLUSIA AVE UNIT B-4
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City | ORANGE CITY
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State | FL
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Zip | 32763-7625
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Country | US
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Telephone | 407-417-3859
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Fax | 407-830-7903
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Provider Business Mailing Address
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Address Line | 1160 COLLINS AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-8421
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Country | US
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Telephone | 386-774-9073
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Fax | 386-775-8044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH1531
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License Number State | FL
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