Provider Demographics
NPI:1083017453
Name:CASTRILLA-COLE, JOANNA (LCSW)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:CASTRILLA-COLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:CASTRILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-0091
Mailing Address - Country:US
Mailing Address - Phone:440-813-5263
Mailing Address - Fax:
Practice Address - Street 1:4726 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6929
Practice Address - Country:US
Practice Address - Phone:440-992-8552
Practice Address - Fax:440-992-6631
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI14506441041C0700X
GACSW0061061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical