Provider Demographics
NPI:1467763235
Name:DECASTRO, MARIA CHONA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CHONA
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:CHONA
Other - Last Name:FORLALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 CABRINI PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1769
Mailing Address - Country:US
Mailing Address - Phone:757-339-4198
Mailing Address - Fax:757-962-6864
Practice Address - Street 1:4490 HOLLAND OFFICE PARK STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1177
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:866-594-3899
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst