Provider Demographics
NPI:1427669787
Name:CASTRO, CHRISTIE TERESE (CADC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:TERESE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4309
Mailing Address - Country:US
Mailing Address - Phone:805-712-9913
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4558
Practice Address - Country:US
Practice Address - Phone:805-781-4275
Practice Address - Fax:805-781-1227
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1564750171M00000X
CAR1405360920171M00000X
CACI38300423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator