Healthcare Provider Details

I. General information

NPI: 1750020442
Provider Name (Legal Business Name): MARISA LISETTE CASTRO APC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 PIEDMONT RD NE STE 330
ATLANTA GA
30305-1552
US

IV. Provider business mailing address

3520 PIEDMONT RD NE STE 330
ATLANTA GA
30305-1552
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-2008
  • Fax:
Mailing address:
  • Phone: 404-351-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC008514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: