Provider Demographics
NPI:1487892006
Name:SEYMOUR, KIMBERLY CASTRO (MSCM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CASTRO
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MSCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9327
Mailing Address - Country:US
Mailing Address - Phone:678-947-6550
Mailing Address - Fax:
Practice Address - Street 1:564 PEACHTREE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9327
Practice Address - Country:US
Practice Address - Phone:678-947-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2301679103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst