Provider Demographics
NPI:1740735240
Name:ST LOUIS, ERIN KILLIANY
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KILLIANY
Last Name:ST LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARGARET
Other - Last Name:KILLIANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10640 PAGE AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4012
Mailing Address - Country:US
Mailing Address - Phone:571-242-2991
Mailing Address - Fax:
Practice Address - Street 1:10640 PAGE AVE STE 330
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4012
Practice Address - Country:US
Practice Address - Phone:571-242-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106H00000X103K00000X
VA0717001363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst