Provider Demographics
NPI:1093848590
Name:KILPATRICK, LESLIE CATHERINE (MED, MSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CATHERINE
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:MED, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 KENTMERE SQ
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6062
Mailing Address - Country:US
Mailing Address - Phone:703-691-3578
Mailing Address - Fax:
Practice Address - Street 1:4121 KENTMERE SQ
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-691-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076791041C0700X
MD229771041C0700X
DCLC500811011041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical