Provider Demographics
NPI:1376184218
Name:KIRBY, QUENNETTA (LCSWA)
Entity type:Individual
Prefix:
First Name:QUENNETTA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3045
Mailing Address - Country:US
Mailing Address - Phone:704-283-9055
Mailing Address - Fax:
Practice Address - Street 1:1112 SKYWAY DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3045
Practice Address - Country:US
Practice Address - Phone:704-283-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0124691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical