Healthcare Provider Details

I. General information

NPI: 1295800035
Provider Name (Legal Business Name): CHRISTOPHER WILLIAM NICASTRO LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S HENRY ST
DELAWARE OH
43015-2978
US

IV. Provider business mailing address

41 SPICEWOOD LN
POWELL OH
43065-7903
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-4482
  • Fax:
Mailing address:
  • Phone: 740-657-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0002833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: