Provider Demographics
NPI:1790478790
Name:CASTILLO, EVANGELINA (MA)
Entity Type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 SHELBY BOTTOMS BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2558
Mailing Address - Country:US
Mailing Address - Phone:770-539-1808
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE N STE 1220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1640
Practice Address - Country:US
Practice Address - Phone:615-538-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health