Provider Demographics
NPI:1831756212
Name:CASTILLO, ANGELICA (LCPC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N SPICELAND PL
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3165
Mailing Address - Country:US
Mailing Address - Phone:208-254-1035
Mailing Address - Fax:208-477-5203
Practice Address - Street 1:824 17TH AVE S STE 14
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4780
Practice Address - Country:US
Practice Address - Phone:208-254-1035
Practice Address - Fax:208-477-5203
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-9024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional