Provider Demographics
NPI:1790955375
Name:FAJARDO, RICHARD CASTILLO (MA, LPCC, NCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CASTILLO
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6884 AUGUSTA HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8605
Mailing Address - Country:US
Mailing Address - Phone:505-385-4284
Mailing Address - Fax:505-248-7298
Practice Address - Street 1:500 GOLD AVE SW FL 11
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3118
Practice Address - Country:US
Practice Address - Phone:505-385-4284
Practice Address - Fax:505-248-7298
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0074081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health