Individual
MR. AGUSTIN JOSEPH CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPA, MS, LPC
Contact information
Practice address
7825 MIDLOTHIAN TPKE STE 203, NORTH CHESTERFIELD, VA 23235-5247
(229) 412-8125
Mailing address
7825 MIDLOTHIAN TPKE STE 203, NORTH CHESTERFIELD, VA 23235-5247
(229) 412-8125
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701006356
VA
101YM0800X
Mental Health Counselor
0701006356
VA
101YP2500X
Professional Counselor
Primary
0701006356
VA
103K00000X
Behavior Analyst
0701006356
VA
Other
Enumeration date
09/02/2014
Last updated
02/07/2017
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