1881331965 NPI number — LAURA GONZALEZ CASTRO QUALIFIED MENTAL HEA

Table of content: LAURA GONZALEZ CASTRO QUALIFIED MENTAL HEA (NPI 1881331965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881331965 NPI number — LAURA GONZALEZ CASTRO QUALIFIED MENTAL HEA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ CASTRO
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
QUALIFIED MENTAL HEA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881331965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 CUNNINGHAM DRIVE,
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-838-1960
Provider Business Mailing Address Fax Number:
757-838-3280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 CUNNINGHAM DRIVE,
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-838-1960
Provider Business Practice Location Address Fax Number:
757-838-3280
Provider Enumeration Date:
05/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0704014807 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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