Basic Information
| Provider Information | |||||||||
| NPI: | 1801131297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIRKEL | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241122810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766327128 | ||||||||
| FaxNumber: | 2766320127 | ||||||||
| Practice Location | |||||||||
| Address1: | 22280 JEB STUART HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241712999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766944570 | ||||||||
| FaxNumber: | 2766943445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701005369 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 004945221 | 01 | VA | MEDICAID # FOR GROUP | OTHER |