Healthcare Provider Details

I. General information

NPI: 1801724836
Provider Name (Legal Business Name): CHICO CASTILLO SUD COUNSELOR 2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 WATERLOO RD
STOCKTON CA
95205-4256
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-940-5662
  • Fax:
Mailing address:
  • Phone: 209-373-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: