MEDICARE: MR. RICHARD W CASTLE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0701003393	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	460998	OTHER	VA	ANTHEM MENTAL HEALTH
2	146152	OTHER	VA	ANTHEM MENTAL HEALTH
3	O80137M	OTHER	VA	SENTERA MENTAL HEALTH
4	2119464	OTHER	VA	CIGNA MENTAL HEALTH

General Provider Information

NPI Number	:	1265496731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD W CASTLE LPC

Provider Business Mailing Address
First Line	:	504 WILBORN AVE
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3120
Country	:	US
Telephone Number	:	434-572-6935
Fax Number	:	434-572-4827

Provider Business Practice Location Address
First Line	:	504 WILBORN AVE
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3120
Country	:	US
Telephone Number	:	434-572-6935
Fax Number	:	434-572-4827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/09/2007

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