Basic Information
| Provider Information | |||||||||
| NPI: | 1124399407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTLE | ||||||||
| FirstName: | WALTER | ||||||||
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| Credential: | LCSW, MCAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 MAHAN CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505215700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 ANDREWS AVE. | ||||||||
| Address2: | LYSTER ARMY HEALTH CLINIC RM F-123 | ||||||||
| City: | FORT RUCKER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342557797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ADC-011017-2015 | FL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | SW6086 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.