| Doctor Name: | LYSA KIRBY |
| NPI Number: | 1053787416 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LGPC |
| License Number: | LGP5944 |
| Business Practice Address: | 6100 Radio Station Road La Plata, MD - 206462984 |
| Business Phone Number: | 3016099887 |
| Business Fax Number: | 3016099091 |
| Mailing Address: | Po Box 2924, LA PLATA |
| State: | MD |
| Postal Code: | 206462984 |
| Phone Number: | 3016099887 |
| Fax Number: | 3016099091 |
| NPI Enumeration Date: | 08/19/2015 |
| NPI Last Update Date: | 08/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LGP5944 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |