Provider Demographics
NPI:1124399407
Name:CASTLE, WALTER (LCSW, MCAP)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:CASTLE
Suffix:
Gender:M
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5443
Mailing Address - Country:US
Mailing Address - Phone:850-521-5700
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVE.
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC RM F-123
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-011017-2015101YA0400X
FLSW60861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)