Provider Demographics
NPI:1043885510
Name:CASTRO, ADAM ABEL (LPCC 9442)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ABEL
Last Name:CASTRO
Suffix:
Gender:M
Credentials:LPCC 9442
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S. HIGHLAND SPRINGS DRIVE
Mailing Address - Street 2:STE 6-C #158
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:760-994-7522
Mailing Address - Fax:
Practice Address - Street 1:300 S. HIGHLAND SPRINGS DRIVE
Practice Address - Street 2:STE 6-C #158
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220
Practice Address - Country:US
Practice Address - Phone:760-994-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional