Provider Demographics
NPI:1174363642
Name:CASTELLANO, ANGELA MICHELE (SUDCCII)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:SUDCCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 LARSON AVE.#6
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-661-4270
Mailing Address - Fax:
Practice Address - Street 1:12781 JOSEPHINE ST.
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841
Practice Address - Country:US
Practice Address - Phone:714-661-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)