Provider Demographics
NPI:1730915992
Name:CASTILLO, MELISSA GRACE (CADC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-2115
Mailing Address - Country:US
Mailing Address - Phone:919-208-7677
Mailing Address - Fax:
Practice Address - Street 1:8815 UNIVERSITY EAST DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4106
Practice Address - Country:US
Practice Address - Phone:980-406-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)