Provider Demographics
NPI:1457940165
Name:CASTILLO, RAYMOND G (MA, LMFT, LCAS-A)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MA, LMFT, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10835 GARDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4845
Mailing Address - Country:US
Mailing Address - Phone:954-865-0855
Mailing Address - Fax:
Practice Address - Street 1:11020 S TRYON ST STE 408
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6662
Practice Address - Country:US
Practice Address - Phone:980-236-1660
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27066101YA0400X
NC12302A101YM0800X
NC2408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)