Provider Demographics
NPI:1083856819
Name:KIRKUP, JOSEPHINE KIM (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:KIM
Last Name:KIRKUP
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6339
Mailing Address - Country:US
Mailing Address - Phone:404-805-0095
Mailing Address - Fax:
Practice Address - Street 1:1902 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6339
Practice Address - Country:US
Practice Address - Phone:404-805-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional