Provider Demographics
NPI:1013688068
Name:CASTILLO, JAIME ALBERTO (APC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALBERTO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:ALBERTO
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APC
Mailing Address - Street 1:2010 LENOX RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3063
Mailing Address - Country:US
Mailing Address - Phone:678-522-4717
Mailing Address - Fax:
Practice Address - Street 1:1401 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3023
Practice Address - Country:US
Practice Address - Phone:678-522-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional