Provider Demographics
NPI:1033232673
Name:KIRK, THOMAS J (MSW; LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:KIRK
Suffix:
Gender:M
Credentials:MSW; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 MOUNT VERNON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VANDERBILT
Mailing Address - State:MI
Mailing Address - Zip Code:49795-9513
Mailing Address - Country:US
Mailing Address - Phone:989-983-4525
Mailing Address - Fax:
Practice Address - Street 1:1500 WEISS ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5251
Practice Address - Country:US
Practice Address - Phone:734-222-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical