Provider Demographics
NPI:1578209441
Name:CAITLIN KIRBY LLC
Entity Type:Organization
Organization Name:CAITLIN KIRBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:251-610-6140
Mailing Address - Street 1:8973 LONGUE VUE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6390
Mailing Address - Country:US
Mailing Address - Phone:251-610-6140
Mailing Address - Fax:
Practice Address - Street 1:8851 RAND AVE STE B
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9138
Practice Address - Country:US
Practice Address - Phone:251-610-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty