Provider Demographics
NPI:1609292812
Name:CARTER WINOKUR, KIM (MA,IMH)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:CARTER WINOKUR
Suffix:
Gender:F
Credentials:MA,IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7713
Mailing Address - Country:US
Mailing Address - Phone:386-423-9161
Mailing Address - Fax:
Practice Address - Street 1:136 JULIA ST UNIT 100
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7713
Practice Address - Country:US
Practice Address - Phone:386-423-9161
Practice Address - Fax:386-423-3094
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11593101YM0800X, 101YP2500X
FL13644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health