Individual
DELISSA L CASTLEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CADCII
Contact information
Practice address
7112 HOME OF GRACE DR, GAUTIER, MS 39553-2728
(228) 497-1312
Mailing address
7112 HOME OF GRACE DR, GAUTIER, MS 39553-2728
(228) 497-1312
(228) 497-7340
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1412
MS
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
MS
101YP2500X
Professional Counselor
Primary
1412
MS
251B00000X
Case Management Agency
—
MS
Other
Enumeration date
06/04/2020
Last updated
06/04/2020
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