Provider Demographics
NPI:1194000539
Name:CASTANO, KIMBERLY SUSAN (LCAS, LPC, CCS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:CASTANO
Suffix:
Gender:F
Credentials:LCAS, LPC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BALSAM
Mailing Address - State:NC
Mailing Address - Zip Code:28707-0250
Mailing Address - Country:US
Mailing Address - Phone:828-226-5533
Mailing Address - Fax:828-627-1307
Practice Address - Street 1:33 SHARON LYNNE WAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8285
Practice Address - Country:US
Practice Address - Phone:828-226-5533
Practice Address - Fax:828-627-1307
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
NC1910101YA0400X
NC8120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional