Provider Demographics
NPI:1487490801
Name:VAN KIRK, ZOE (LCMHCA)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:VAN KIRK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 77 CENTER DR STE 245
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2705
Mailing Address - Country:US
Mailing Address - Phone:612-508-9403
Mailing Address - Fax:704-909-4009
Practice Address - Street 1:5600 77 CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2705
Practice Address - Country:US
Practice Address - Phone:612-508-9403
Practice Address - Fax:704-909-4009
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health