Provider Demographics
NPI:1699532143
Name:KILGORE-ROBINSON, ELISABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:KILGORE-ROBINSON
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 1:5341 BOWERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4509
Mailing Address - Country:US
Mailing Address - Phone:703-901-6350
Mailing Address - Fax:
Practice Address - Street 1:3953 PENDER DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0970
Practice Address - Country:US
Practice Address - Phone:703-204-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty