Provider Demographics
NPI:1821673179
Name:WHITE-CASTLEMAN, CRYSTAL SHARLENE
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:SHARLENE
Last Name:WHITE-CASTLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:SHARLENE
Other - Last Name:WHITE-CASTLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 292966
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-2966
Mailing Address - Country:US
Mailing Address - Phone:916-841-4751
Mailing Address - Fax:
Practice Address - Street 1:RIVER OAK CENTER FOR CHILDREN
Practice Address - Street 2:9412 BIG HORN BLVD, SUITE 6
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-609-5155
Practice Address - Fax:916-609-5161
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S0000X101YA0400X
CAAPCC11010101YM0800X, 101YP2500X
CAAMFT130750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional