Provider Demographics
NPI:1972755692
Name:KILLE, LESLIE GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GRACE
Last Name:KILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:GRACE
Other - Last Name:KILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:7780 S BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2633
Mailing Address - Country:US
Mailing Address - Phone:727-560-7546
Mailing Address - Fax:
Practice Address - Street 1:7780 S BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:727-056-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002251101YA0400X
COCSW.099264901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)