1861483315 NPI number — MRS. PAMELA PARKER KIRKMAN LCSW MAC

Table of content: MRS. PAMELA PARKER KIRKMAN LCSW MAC (NPI 1861483315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861483315 NPI number — MRS. PAMELA PARKER KIRKMAN LCSW MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKMAN
Provider First Name:
PAMELA
Provider Middle Name:
PARKER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW MAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861483315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13105 SIR SCOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23831-4753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-796-1882
Provider Business Mailing Address Fax Number:
804-734-9601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 24TH ST
Provider Second Line Business Practice Location Address:
SUITE D-26
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23801-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-734-9601
Provider Business Practice Location Address Fax Number:
804-734-9193
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904001331 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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