Healthcare Provider Details

I. General information

NPI: 1235891177
Provider Name (Legal Business Name): JENNIFER NICHOLE CASTRO CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 11/08/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 D ST
ANTIOCH CA
94509-2571
US

IV. Provider business mailing address

1915 D ST
ANTIOCH CA
94509-2571
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-3673
  • Fax:
Mailing address:
  • Phone: 925-754-3673
  • Fax: 925-754-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: