Provider Demographics
NPI:1881930071
Name:KIRKLAND, MARILYN A (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 POPLAR RDG
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2842
Mailing Address - Country:US
Mailing Address - Phone:404-643-2457
Mailing Address - Fax:678-203-2409
Practice Address - Street 1:1585 OLD NORCROSS RD STE 201D
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4043
Practice Address - Country:US
Practice Address - Phone:404-643-2457
Practice Address - Fax:678-203-2409
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0016771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical