=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366076952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ELIZABETH KIRKPATRICK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2020
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7350 HERITAGE VILLAGE PLZ UNIT 102
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20155-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-216-2285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6479 GOOCHLAND ST
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20187-4175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-554-5975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0704008553
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------