Provider Demographics
NPI:1912207200
Name:CASTRO, TONIA LINO (CSAC)
Entity Type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:LINO
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N. 181 W.
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627
Mailing Address - Country:US
Mailing Address - Phone:435-283-9934
Mailing Address - Fax:435-283-9935
Practice Address - Street 1:90 N 161 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-5542
Practice Address - Country:US
Practice Address - Phone:435-283-9934
Practice Address - Fax:435-283-9935
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7748957-6005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)