Provider Demographics
NPI:1881331965
Name:GONZALEZ CASTRO, LAURA (QUALIFIED MENTAL HEA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GONZALEZ CASTRO
Suffix:
Gender:F
Credentials:QUALIFIED MENTAL HEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 CUNNINGHAM DRIVE,
Mailing Address - Street 2:STE 400
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-838-1960
Mailing Address - Fax:757-838-3280
Practice Address - Street 1:2021 CUNNINGHAM DRIVE,
Practice Address - Street 2:STE 400
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-838-1960
Practice Address - Fax:757-838-3280
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional