Provider Demographics
NPI:1225030190
Name:CASTINE, DAVID (LMSW, LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CASTINE
Suffix:
Gender:M
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2712
Mailing Address - Country:US
Mailing Address - Phone:248-854-1708
Mailing Address - Fax:
Practice Address - Street 1:29260 FRANKLIN RD STE 115
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1144
Practice Address - Country:US
Practice Address - Phone:248-854-1708
Practice Address - Fax:248-436-2844
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005312106H00000X
MI6801040951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26426 353Medicare PIN