Provider Demographics
NPI:1881262939
Name:ANDREA KIRK COUNSELING, PSC
Entity type:Organization
Organization Name:ANDREA KIRK COUNSELING, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:502-287-9110
Mailing Address - Street 1:4010 DUPONT CIRCLE, SUITE 228
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-287-9110
Mailing Address - Fax:502-384-0478
Practice Address - Street 1:4010 DUPONT CIRCLE, SUITE 228
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-287-9110
Practice Address - Fax:502-384-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12649733OtherCAQH
KY7100274630Medicaid