Individual
ALAN B KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, LCSW
Contact information
Practice address
1605 ROBERTA DR SW, MARIETTA, GA 30008-3855
(770) 419-3120
(770) 419-3121
Mailing address
1605 ROBERTA DR SW, MARIETTA, GA 30008-3855
(770) 419-3120
(770) 419-3121
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW003435
LCSW LICENSE #
GA
Enumeration date
08/11/2011
Last updated
08/11/2011
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