Provider Demographics
NPI:1922026194
Name:SKILTON, KATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SKILTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 OLD LEE HWY
Mailing Address - Street 2:73-A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2429
Mailing Address - Country:US
Mailing Address - Phone:703-591-8668
Mailing Address - Fax:703-691-8496
Practice Address - Street 1:3921 OLD LEE HWY
Practice Address - Street 2:73-A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2429
Practice Address - Country:US
Practice Address - Phone:703-591-8668
Practice Address - Fax:703-691-8496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000139OtherVALUOPTIONS PROVIDER ID
VA101366Medicaid
VA5512003OtherAETNA PROVIDER ID