Provider Demographics
NPI:1104471762
Name:IRISH, KERRY C (MSW, LCSW, OSW-C)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:C
Last Name:IRISH
Suffix:
Gender:F
Credentials:MSW, LCSW, OSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 E CHESTNUT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2378
Mailing Address - Country:US
Mailing Address - Phone:207-212-6372
Mailing Address - Fax:
Practice Address - Street 1:184 E CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2378
Practice Address - Country:US
Practice Address - Phone:207-212-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO118541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical