Provider Demographics
NPI:1649691452
Name:CASTONGUAY, ERIC (LCMHC, LPCC, MHC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CASTONGUAY
Suffix:
Gender:M
Credentials:LCMHC, LPCC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 4TH ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2104
Mailing Address - Country:US
Mailing Address - Phone:802-760-8214
Mailing Address - Fax:
Practice Address - Street 1:2901 JUAN TABO BLVD NE # 101C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1886
Practice Address - Country:US
Practice Address - Phone:802-760-8214
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0131630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health