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General NPI Number Information
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NPI Number | 1073022752
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Entity Type | Individual
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Provider Name | JAMES IRA KIRK CDCA II , SWA
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Gender | Male
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11100 STATE ROUTE 550
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City | ATHENS
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State | OH
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Zip | 45701-8839
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Country | US
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Telephone | 740-592-1134
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Fax | 740-422-1513
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Provider Business Mailing Address
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Address Line | 11100 STATE ROUTE 550
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City | ATHENS
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State | OH
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Zip | 45701
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Country | US
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Telephone | 740-592-1134
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Fax | 740-422-1513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | W1500061
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 141741
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License Number State | OH
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