Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10953 | TX |
NPI | 1003306143 |
---|---|
Provider Name | Maritza Castillo |
First Address | Dallas, TX 75243-7035 |
Second Address | Dallas, TX 75243-7035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 09/06/2020 |