Basic Information
| Provider Information | |||||||||
| NPI: | 1760954184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGA | ||||||||
| FirstName: | AUGUST | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | CDC1/BHC1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 E REVOLUTIONARY WAY # 870238 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996546715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075624155 | ||||||||
| FaxNumber: | 9075632891 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 BRAGAW ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995083463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075624155 | ||||||||
| FaxNumber: | 9075632891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2018 | ||||||||
| LastUpdateDate: | 12/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1847 | AK | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.