Provider Demographics
NPI:1265496731
Name:CASTLE, RICHARD W (LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:CASTLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3120
Mailing Address - Country:US
Mailing Address - Phone:434-572-6935
Mailing Address - Fax:434-572-4827
Practice Address - Street 1:504 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3120
Practice Address - Country:US
Practice Address - Phone:434-572-6935
Practice Address - Fax:434-572-4827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003393101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA460998OtherANTHEM MENTAL HEALTH
VA146152OtherANTHEM MENTAL HEALTH
VAO80137MOtherSENTERA MENTAL HEALTH
VA2119464OtherCIGNA MENTAL HEALTH