Provider Demographics
NPI:1164575155
Name:KIRBY, AMANDA LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:MICHELICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4504 CHARLOTTESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3618
Mailing Address - Country:US
Mailing Address - Phone:336-457-0827
Mailing Address - Fax:
Practice Address - Street 1:1175 REVOLUTION MILL DR STE 29-2
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5079
Practice Address - Country:US
Practice Address - Phone:336-457-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5421101YP2500X, 251S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103295Medicaid