Provider Demographics
NPI:1487986626
Name:LALOR, KIRK MITCHELL (PH D)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:MITCHELL
Last Name:LALOR
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CENTURY PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3154
Mailing Address - Country:US
Mailing Address - Phone:404-325-0304
Mailing Address - Fax:404-325-3663
Practice Address - Street 1:2200 CENTURY PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3154
Practice Address - Country:US
Practice Address - Phone:404-325-0304
Practice Address - Fax:404-325-3663
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist