Healthcare Provider Details

I. General information

NPI: 1821673179
Provider Name (Legal Business Name): MRS. CRYSTAL SHARLENE WHITE-CASTLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. CRYSTAL SHARLENE WHITE-CASTLEMAN

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 05/12/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIVER OAK CENTER FOR CHILDREN 9412 BIG HORN BLVD, SUITE 6
ELK GROVE CA
95758
US

IV. Provider business mailing address

PO BOX 292966
SACRAMENTO CA
95829-2966
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5155
  • Fax: 916-609-5161
Mailing address:
  • Phone: 916-841-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number251S0000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC11010
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC11010
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT130750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: