Provider Demographics
NPI:1326881129
Name:CASTRO MEJIA, EDESA B
Entity type:Individual
Prefix:
First Name:EDESA
Middle Name:B
Last Name:CASTRO MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 ANDREW CT APT 201
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2355
Mailing Address - Country:US
Mailing Address - Phone:240-681-4171
Mailing Address - Fax:
Practice Address - Street 1:5074 G ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5901
Practice Address - Country:US
Practice Address - Phone:202-246-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral