Provider Demographics
NPI:1689548117
Name:AUSTIN, ANTHONY DEREK II (NCC, BCCC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DEREK
Last Name:AUSTIN
Suffix:II
Gender:M
Credentials:NCC, BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2308
Mailing Address - Country:US
Mailing Address - Phone:269-363-6583
Mailing Address - Fax:
Practice Address - Street 1:17800 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2308
Practice Address - Country:US
Practice Address - Phone:269-363-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor