Provider Demographics
NPI:1316427768
Name:KIRK, NANCY ELISABETH (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELISABETH
Last Name:KIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16451 RUNNING POST CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1058
Mailing Address - Country:US
Mailing Address - Phone:703-577-3299
Mailing Address - Fax:703-815-7952
Practice Address - Street 1:163 FORT EVANS RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4420
Practice Address - Country:US
Practice Address - Phone:571-455-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040106091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical