Provider Demographics
NPI:1174731590
Name:KIRK, MATTHEWS FLORENCE (MSW)
Entity type:Individual
Prefix:MISS
First Name:MATTHEWS
Middle Name:FLORENCE
Last Name:KIRK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 DEERWOOD XING
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5353
Mailing Address - Country:US
Mailing Address - Phone:601-608-4223
Mailing Address - Fax:601-982-5624
Practice Address - Street 1:571 E BEASLEY RD
Practice Address - Street 2:SUITE -A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3042
Practice Address - Country:US
Practice Address - Phone:601-608-4223
Practice Address - Fax:601-982-5624
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW08631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical