Provider Demographics
NPI:1073022752
Name:KIRK, JAMES IRA (CDCA II , SWA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:IRA
Last Name:KIRK
Suffix:
Gender:M
Credentials:CDCA II , SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 STATE ROUTE 550
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-592-1134
Mailing Address - Fax:740-422-1513
Practice Address - Street 1:11100 STATE ROUTE 550
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8839
Practice Address - Country:US
Practice Address - Phone:740-592-1134
Practice Address - Fax:740-422-1513
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW1500061104100000X
OH141741101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker