Provider Demographics
NPI:1295187896
Name:AMANDA KIRBY COUNSELING, PC
Entity Type:Organization
Organization Name:AMANDA KIRBY COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, EDS, LPC
Authorized Official - Phone:336-457-0827
Mailing Address - Street 1:1175 REVOLUTION MILL DRIVE
Mailing Address - Street 2:SUITE 29-2
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-457-0827
Mailing Address - Fax:877-616-4840
Practice Address - Street 1:1175 REVOLUTION MILL DRIVE
Practice Address - Street 2:SUITE 29-2
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-457-0827
Practice Address - Fax:877-616-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103295Medicaid