Provider Demographics
NPI:1649739269
Name:CASTILLO, VERONICA (LGPC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1102
Mailing Address - Country:US
Mailing Address - Phone:443-433-5900
Mailing Address - Fax:
Practice Address - Street 1:2600 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1102
Practice Address - Country:US
Practice Address - Phone:443-433-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional