Provider Demographics
NPI:1811255904
Name:KIRK, APRIL GALE (LCSW)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:GALE
Last Name:KIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:GALE
Other - Last Name:WILTSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3724
Mailing Address - Country:US
Mailing Address - Phone:479-705-1634
Mailing Address - Fax:479-705-1635
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3724
Practice Address - Country:US
Practice Address - Phone:479-705-1634
Practice Address - Fax:479-705-1635
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8571-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0157Medicaid
AKK0000WCHCPMedicare PIN