Provider Demographics
NPI:1215950332
Name:BIRDSELL, KEVIN R (LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:BIRDSELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 TWIN HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5682
Mailing Address - Country:US
Mailing Address - Phone:804-592-2793
Mailing Address - Fax:804-592-2794
Practice Address - Street 1:5352 TWIN HICKORY RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5682
Practice Address - Country:US
Practice Address - Phone:804-592-2793
Practice Address - Fax:804-592-2794
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical