Healthcare Provider Details

I. General information

NPI: 1710238043
Provider Name (Legal Business Name): MELINDA ROSE COLLINS KIRBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 GROVE RD
MIDLOTHIAN VA
23114-2666
US

IV. Provider business mailing address

831 GROVE RD
MIDLOTHIAN VA
23114-2666
US

V. Phone/Fax

Practice location:
  • Phone: 804-743-0960
  • Fax:
Mailing address:
  • Phone: 804-743-0960
  • Fax: 804-441-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904030100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: