Provider Demographics
NPI:1730311291
Name:KINKADE, VIRGINIA PEMBERTON PATTON (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:PEMBERTON PATTON
Last Name:KINKADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:124 E MAIN ST SUITE 2
Practice Address - Street 2:THE CHICKASAW NATION DEPT OF FAMILY SERVICES
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-310-7993
Practice Address - Fax:405-878-4708
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
OK48541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker