Provider Demographics
NPI:1033981063
Name:GILLIN, KIRA ASHLEY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:ASHLEY
Last Name:GILLIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SUDLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21623-1209
Mailing Address - Country:US
Mailing Address - Phone:630-835-6550
Mailing Address - Fax:
Practice Address - Street 1:29512 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7225
Practice Address - Country:US
Practice Address - Phone:630-835-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD260271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical