Individual
JESSICA KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
689 CENTRAL AVE, BARBOURSVILLE, WV 25504-1315
(303) 733-3331
Mailing address
PO BOX 219, BARBOURSVILLE, WV 25504-0219
(304) 633-3434
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
BP00945114
WV
1041C0700X
Clinical Social Worker
Primary
DP00945114
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP00945114
(LGSW) LICENSED GRADUATE SOCIAL WORKER
WV
01
—
DP00945114
(LICSW)LICENSED INDEPENDENT CLINICAL SOCIAL WORKER
WV
Enumeration date
10/16/2017
Last updated
03/19/2021
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