Individual
CONSTANCE LOU KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.C.-S
Contact information
Practice address
149 HAMER RD, GEORGETOWN, OH 45121-9497
(937) 515-3060
Mailing address
104 LAKEWOOD LN, GEORGETOWN, OH 45121-9037
(937) 515-3060
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
071010
OH
101YM0800X
Mental Health Counselor
Primary
E0008453
OH
Other
Enumeration date
11/20/2008
Last updated
11/20/2008
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