Healthcare Provider Details

I. General information

NPI: 1720235542
Provider Name (Legal Business Name): KAREN SUE KIRK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 IRON GATE DR STE 101
WILMINGTON NC
28412-6624
US

IV. Provider business mailing address

PO BOX 16570
WILMINGTON NC
28408-6570
US

V. Phone/Fax

Practice location:
  • Phone: 910-202-9113
  • Fax: 910-202-9289
Mailing address:
  • Phone: 910-202-9113
  • Fax: 910-202-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3894
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: