Basic Information
| Provider Information | |||||||||
| NPI: | 1306907589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7910 SPRINGFIELD VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221523434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034511307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 720 ST . ASAPH STREET | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038386400 | ||||||||
| FaxNumber: | 7038385070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701003878 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 0134 | 01 | VA | CAREFIRST BCBS | OTHER | 546001103002 | 01 | VA | TRICARE | OTHER | 188522 | 01 | VA | ANTHEM | OTHER | 299399 | 01 | VA | AMERIGROUP VIRGINIA INC. | OTHER |