Provider Demographics
NPI:1649361619
Name:CASTILLO, CAROLINA HEATHER (MFTI 63884)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:HEATHER
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MFTI 63884
Other - Prefix:MS
Other - First Name:CAROLINA
Other - Middle Name:HEATHER
Other - Last Name:CALLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618
Mailing Address - Country:US
Mailing Address - Phone:530-747-3496
Mailing Address - Fax:530-753-0398
Practice Address - Street 1:2100 5TH STREET
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618
Practice Address - Country:US
Practice Address - Phone:530-747-3496
Practice Address - Fax:530-753-0398
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 45112106H00000X
CA63884(MFTI)390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist