Provider Demographics
NPI:1972896637
Name:KIRBY, EDWENA (LPC)
Entity Type:Individual
Prefix:DR
First Name:EDWENA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 REYNOLDA RD STE B
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4627
Mailing Address - Country:US
Mailing Address - Phone:336-794-6774
Mailing Address - Fax:336-217-8044
Practice Address - Street 1:2430 REYNOLDA RD STE B
Practice Address - Street 2:SUITE 4
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4627
Practice Address - Country:US
Practice Address - Phone:336-794-6774
Practice Address - Fax:336-217-8044
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional