Provider Demographics
NPI:1114118387
Name:KIRKOVA, MINA (MA, MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:KIRKOVA
Suffix:
Gender:F
Credentials:MA, MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 JACKSON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1459
Mailing Address - Country:US
Mailing Address - Phone:410-988-7247
Mailing Address - Fax:
Practice Address - Street 1:3009 JACKSON RIDGE CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131
Practice Address - Country:US
Practice Address - Phone:410-988-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL44781041C0700X
MD159111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical