Healthcare Provider Details

I. General information

NPI: 1801131297
Provider Name (Legal Business Name): JANE L SIRKEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22280 JEB STUART HWY
STUART VA
24171-2999
US

IV. Provider business mailing address

24 CLAY ST
MARTINSVILLE VA
24112-2810
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4570
  • Fax: 276-694-3445
Mailing address:
  • Phone: 276-632-7128
  • Fax: 276-632-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005369
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: