Provider Demographics
NPI:1265527659
Name:CASTILLO, CARLOS R (LCSW,ACSW,BCD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:R
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LCSW,ACSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CORAL CT
Mailing Address - Street 2:APT 1
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704-1346
Mailing Address - Country:US
Mailing Address - Phone:701-727-5753
Mailing Address - Fax:
Practice Address - Street 1:10 MISSLE AVE
Practice Address - Street 2:5MDOS/SGOHP
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58705-5003
Practice Address - Country:US
Practice Address - Phone:701-723-5527
Practice Address - Fax:701-729-5573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical