Provider Demographics
NPI:1053963686
Name:KIRBY, LARENCE (LPCMH)
Entity type:Individual
Prefix:
First Name:LARENCE
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:CHESWOLD
Mailing Address - State:DE
Mailing Address - Zip Code:19936-0386
Mailing Address - Country:US
Mailing Address - Phone:302-213-3121
Mailing Address - Fax:
Practice Address - Street 1:109 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7313
Practice Address - Country:US
Practice Address - Phone:302-213-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health