Provider Demographics
NPI:1104364074
Name:CAPSTONE MEDICAL RESOURCES, LLC
Entity Type:Organization
Organization Name:CAPSTONE MEDICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:205-503-1643
Mailing Address - Street 1:300 CORNWALL
Mailing Address - Street 2:
Mailing Address - City:MAYLENE
Mailing Address - State:AL
Mailing Address - Zip Code:35114-5455
Mailing Address - Country:US
Mailing Address - Phone:205-503-1642
Mailing Address - Fax:
Practice Address - Street 1:3500 BLUE LAKE DR
Practice Address - Street 2:STE 340
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-1907
Practice Address - Country:US
Practice Address - Phone:205-503-1643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty