Provider Demographics
NPI:1871612358
Name:KIRTLEY, PATRICIA LOUISE (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 PEAKLAND PL
Mailing Address - Street 2:#3
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2045
Mailing Address - Country:US
Mailing Address - Phone:434-385-3428
Mailing Address - Fax:434-385-3428
Practice Address - Street 1:3837 PEAKLAND PL
Practice Address - Street 2:#3
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2045
Practice Address - Country:US
Practice Address - Phone:434-385-3428
Practice Address - Fax:434-385-3428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001533101YM0800X
VA0717000718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1708491-001OtherPCHP
VAA957423OtherVALUE OPTIONS
VI097954OtherANTHEM BCBS