Healthcare Provider Details

I. General information

NPI: 1063901650
Provider Name (Legal Business Name): CASTLE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 FIDDLER CT
TALLAHASSEE FL
32308-4450
US

IV. Provider business mailing address

1840 FIDDLER CT
TALLAHASSEE FL
32308-4450
US

V. Phone/Fax

Practice location:
  • Phone: 850-631-2028
  • Fax:
Mailing address:
  • Phone: 850-631-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW6086
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER CASTLE
Title or Position: THERAPIST
Credential: LCSW. MCAP
Phone: 850-631-2028