Provider Demographics
NPI:1700181872
Name:CAPSTRAW, KIMBERLY WESTBROOK (MS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:WESTBROOK
Last Name:CAPSTRAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:27198 WOODHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9615
Mailing Address - Country:US
Mailing Address - Phone:407-227-9245
Mailing Address - Fax:352-735-1551
Practice Address - Street 1:115 E 4TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5550
Practice Address - Country:US
Practice Address - Phone:407-227-9245
Practice Address - Fax:352-735-1551
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist