Provider Demographics
NPI:1497961981
Name:CAPTAIN, CAROL L (CAROL CAPTAIN, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:CAPTAIN
Suffix:
Gender:F
Credentials:CAROL CAPTAIN, LMFT
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CAPTAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAROL CAPTAIN,LMFT
Mailing Address - Street 1:8081 PALMETTO PALM CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2729
Mailing Address - Country:US
Mailing Address - Phone:954-465-5544
Mailing Address - Fax:
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 308
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4961
Practice Address - Country:US
Practice Address - Phone:954-465-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2680101YA0400X
FLMT1975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)