Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1225300114 |
---|---|
Provider Name | Dr. Julia Kirk |
First Address | Los Angeles, CA 90068-2655 |
Second Address | Tarzana, CA 91356-1411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2012 |
Last Update Date | 07/02/2012 |