Provider Demographics
NPI:1356505242
Name:CASTRILLO, KOSTANDINA ANAGNOSTOPOULOS (LMFT)
Entity Type:Individual
Prefix:
First Name:KOSTANDINA
Middle Name:ANAGNOSTOPOULOS
Last Name:CASTRILLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1326
Mailing Address - Country:US
Mailing Address - Phone:925-864-1617
Mailing Address - Fax:
Practice Address - Street 1:2351 OLIVERA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1626
Practice Address - Country:US
Practice Address - Phone:925-603-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA84876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health