Provider Demographics
NPI:1619652377
Name:KIRBY, RUBY (EDS,MAC, CCS, CACII)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:EDS,MAC, CCS, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1218
Mailing Address - Country:US
Mailing Address - Phone:404-889-0621
Mailing Address - Fax:
Practice Address - Street 1:4282 MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1218
Practice Address - Country:US
Practice Address - Phone:404-889-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)