Provider Demographics
NPI:1790225480
Name:CASTRO, HOLLY (CDAC CAS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CDAC CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 LICHEN DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1122
Mailing Address - Country:US
Mailing Address - Phone:916-410-1294
Mailing Address - Fax:
Practice Address - Street 1:8230 LICHEN DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1122
Practice Address - Country:US
Practice Address - Phone:916-410-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC16761214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)