Provider Demographics
NPI:1194122424
Name:CASTRO, MICHELLE V (MA, LMHC, SUDP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:V
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MA, LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD # 110
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8514
Mailing Address - Country:US
Mailing Address - Phone:360-434-8369
Mailing Address - Fax:
Practice Address - Street 1:1700 SE MILE HILL DR STE 220
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3553
Practice Address - Country:US
Practice Address - Phone:360-434-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60899092101YA0400X
WAMC60510129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)