Provider Demographics
NPI:1518083500
Name:KIRBY, TRINA WILLETTE
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:WILLETTE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HINES MENTAL HEALTH HOME NO. 2
Mailing Address - Street 2:P.O. BOX 1331
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-1331
Mailing Address - Country:US
Mailing Address - Phone:336-986-2495
Mailing Address - Fax:
Practice Address - Street 1:HINES MENTAL HEALTH HOME NO. 2
Practice Address - Street 2:105 MIDIAN COURT
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5966
Practice Address - Country:US
Practice Address - Phone:336-986-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-1423104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness