Provider Demographics
NPI:1700636529
Name:KIRK, VICTORIA (MS, LPC-IT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BISHOPS WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6214
Mailing Address - Country:US
Mailing Address - Phone:262-939-0742
Mailing Address - Fax:
Practice Address - Street 1:120 BISHOPS WAY STE 111
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6214
Practice Address - Country:US
Practice Address - Phone:262-939-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7764-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional