Provider Demographics
NPI:1437116167
Name:KIRK, RACHEL E (PHD MHC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:KIRK
Suffix:
Gender:F
Credentials:PHD MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 YORKTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-398-0731
Mailing Address - Fax:
Practice Address - Street 1:935 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-781-4380
Practice Address - Fax:401-781-4396
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health