=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124399407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALTER CASTLE LCSW, MCAP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2012
-----------------------------------------------------
Last Update Date | 02/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 ANDREWS AVE. LYSTER ARMY HEALTH CLINIC RM F-123
-----------------------------------------------------
City | FORT RUCKER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-255-7797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 MAHAN CENTER BLVD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-521-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ADC-011017-2015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW6086
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------