Provider Demographics
NPI:1760939318
Name:KIRK, ANDREA (PH D)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4208
Mailing Address - Country:US
Mailing Address - Phone:707-939-5475
Mailing Address - Fax:
Practice Address - Street 1:309 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4208
Practice Address - Country:US
Practice Address - Phone:707-939-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist