Healthcare Provider Details

I. General information

NPI: 1588912513
Provider Name (Legal Business Name): KAREN S. KIRK, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 10/06/2022
Certification Date: 09/26/2022
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

P.O. BOX 16570
WILMINGTON NC
28408
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number3894
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN S. KIRK
Title or Position: OWNER / MANAGER
Credential: PHD
Phone: 910-202-9113