1255665477 NPI number — DR. SARAH BRINLEY KIRLIK PHD, L.C.S.W

Table of content: DR. SARAH BRINLEY KIRLIK PHD, L.C.S.W (NPI 1255665477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255665477 NPI number — DR. SARAH BRINLEY KIRLIK PHD, L.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRLIK
Provider First Name:
SARAH
Provider Middle Name:
BRINLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, L.C.S.W
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:
1255665477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 TW ALEXANDER DR STE 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-6815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-704-1017
Provider Business Mailing Address Fax Number:
919-384-5616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 SURVEYOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27703-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-704-1017
Provider Business Practice Location Address Fax Number:
919-384-5616
Provider Enumeration Date:
09/21/2009

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:  0904016839 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C006409 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6007408 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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