Provider Demographics
NPI:1922164003
Name:KIRBY, JENNIFER SMITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SMITH
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HIGHER LEARNING DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6045
Mailing Address - Country:US
Mailing Address - Phone:919-484-9412
Mailing Address - Fax:
Practice Address - Street 1:200 W WEAVER ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-6009
Practice Address - Country:US
Practice Address - Phone:919-491-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical