Provider Demographics
NPI:1518073691
Name:CASTOR, LINDA (RN, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:CASTOR
Suffix:
Gender:F
Credentials:RN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2855
Mailing Address - Country:US
Mailing Address - Phone:217-416-5667
Mailing Address - Fax:
Practice Address - Street 1:2663 FARRAGUT DR
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1462
Practice Address - Country:US
Practice Address - Phone:217-793-0680
Practice Address - Fax:217-793-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional