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NPI Code Detail

MEDICARE: ALAN B KIRK PHD, LCSW

MEDICARE: ALAN B KIRK PHD, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCSW003435GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CSW003435OTHERGALCSW LICENSE #

General Provider Information

NPI Number : 1659650331
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALAN B KIRK PHD, LCSW
Provider Business Mailing Address
First Line : 1605 ROBERTA DR SW
Second Line :
City : MARIETTA
State : GA
Zip : 30008-3855
Country : US
Telephone Number : 770-419-3120
Fax Number : 770-419-3121
Provider Business Practice Location Address
First Line : 1605 ROBERTA DR SW
Second Line :
City : MARIETTA
State : GA
Zip : 30008-3855
Country : US
Telephone Number : 770-419-3120
Fax Number : 770-419-3121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2011
Last Update Date : 08/11/2011

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Directions to “ ALAN B KIRK PHD, LCSW” Practice Location

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