Healthcare Provider Details

I. General information

NPI: 1770188401
Provider Name (Legal Business Name): CHRISTINA SUE KIRKLAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA SUE PERRY

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 01/25/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JASPER CBOC 1454 JONES DAIRY RD
JASPER AL
35501
US

IV. Provider business mailing address

101 JUDY SMITH DR
GUNTERSVILLE AL
35976-4501
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-7384
  • Fax:
Mailing address:
  • Phone: 205-451-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: