Provider Demographics
NPI:1720555782
Name:CASTLEBERRY, ERIN LYNNE (MS, LGPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:LYNNE
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:MS, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-4711
Mailing Address - Country:US
Mailing Address - Phone:202-550-0109
Mailing Address - Fax:
Practice Address - Street 1:166 DEFENSE HWY STE 203
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8922
Practice Address - Country:US
Practice Address - Phone:410-684-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty