Provider Demographics
NPI:1760800296
Name:CASILLAS, CAROLINA (PHD, LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:PHD, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 LANDS END DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4400
Mailing Address - Country:US
Mailing Address - Phone:956-878-5682
Mailing Address - Fax:
Practice Address - Street 1:1231 AGNES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3272
Practice Address - Country:US
Practice Address - Phone:361-929-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64353101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor