Healthcare Provider Details

I. General information

NPI: 1407586530
Provider Name (Legal Business Name): CAMANI CASTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BOULEVARD NE
ATLANTA GA
30312-1208
US

IV. Provider business mailing address

8920 EVES RD UNIT 769511
ROSWELL GA
30076-0128
US

V. Phone/Fax

Practice location:
  • Phone: 470-889-2224
  • Fax:
Mailing address:
  • Phone: 414-899-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW010542
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009176
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW010542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: