Provider Demographics
NPI:1881343812
Name:ESTFANOUS, YOUSTINA (BA)
Entity type:Individual
Prefix:MISS
First Name:YOUSTINA
Middle Name:
Last Name:ESTFANOUS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3285
Mailing Address - Country:US
Mailing Address - Phone:732-861-7772
Mailing Address - Fax:
Practice Address - Street 1:4000 MURRAY PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5004
Practice Address - Country:US
Practice Address - Phone:434-439-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor