Provider Demographics
NPI:1780721001
Name:KIRCHNER, GEORGE ROY JR (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROY
Last Name:KIRCHNER
Suffix:JR
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 CHENA HOT SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712
Mailing Address - Country:US
Mailing Address - Phone:907-590-0931
Mailing Address - Fax:907-238-9074
Practice Address - Street 1:626 2ND ST STE 201A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3466
Practice Address - Country:US
Practice Address - Phone:907-328-9073
Practice Address - Fax:907-238-9074
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK66101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor