Provider Demographics
NPI:1639357668
Name:KIRBY, JOHNNY L JR (LPA)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:L
Last Name:KIRBY
Suffix:JR
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BROWNING DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6642
Mailing Address - Country:US
Mailing Address - Phone:828-315-1368
Mailing Address - Fax:828-270-7868
Practice Address - Street 1:211 S NC 127 HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3541
Practice Address - Country:US
Practice Address - Phone:828-315-1368
Practice Address - Fax:828-270-7868
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2364103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool