Provider Demographics
NPI:1790489821
Name:CASTILLE, DEVAN WAYNE (CIT)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:WAYNE
Last Name:CASTILLE
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4103
Mailing Address - Country:US
Mailing Address - Phone:225-389-3325
Mailing Address - Fax:225-408-8005
Practice Address - Street 1:216 S FOSTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4103
Practice Address - Country:US
Practice Address - Phone:337-244-6918
Practice Address - Fax:225-408-8005
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5324101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor