Provider Demographics
NPI:1609924729
Name:KIRBY, DONAVON R (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:DONAVON
Middle Name:R
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 ADVENT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8174
Mailing Address - Country:US
Mailing Address - Phone:828-394-9886
Mailing Address - Fax:
Practice Address - Street 1:1001 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4504
Practice Address - Country:US
Practice Address - Phone:828-394-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health